Becoming a Physician: A Comparison of the American, Panamanian, and Spanish Systems

Q&A with Daniel Pittí Freiburghaus, MD

Physicians in the United States are required to complete a four-year undergraduate degree, apply to medical school as a separate graduate-level program, and then complete a four-year medical degree. However, physicians in the rest of the Western world follow a much different path. This summer, I had the opportunity to work with physicians at Parc Tauli University Hospital in Barcelona, Spain. Through my summer experience, I learned a great deal about the challenges that students in other countries face in their journey to becoming practicing physicians.

In this article, we will explore physician pathways in two Spanish-speaking countries, in particular reflecting on their norms in medical school, residency, and throughout the board-certification process.

Can you describe your experience as a Panamanian medical student and intern?

“In Panama, you complete six years of medical school, after which you receive your medical degree. In order to practice as a general practitioner, one is required to complete a two-year internship. During this internship, doctors work for upwards of thirty-six hours at a time without pay. You work so much that it is almost impossible to return home and rest. In addition to normal medical responsibilities, interns are also required to take blood samples, get EKGs, transport patients, call the laboratory, etc. If a doctor wants to specialize, they are required to complete a residency after the internship. These residencies come with even more responsibilities.”

How did you become a physician in Spain?

“While I was working as a physician in Panama, my friend came to Barcelona and became a Family Medicine physician. She told me that in Spain, physicians can return home to rest between their shifts and are also paid for their work. I have a Swiss citizenship, so I decided to prepare for the Médico Interno Residente Exam/Resident Medical Intern Exam (MIR Exam). The MIR Exam is the national medical exam in Spain that ranks doctors and is used to determine their specialization and training hospital location within the Sistema Nacional de Salud/Spanish National Health System (SNS). While still working as an intern in Panama, I prepared for the MIR Exam for over a year. On my first attempt, I passed but was unable to receive the score necessary to practice Radiology in Barcelona, as it is a competitive residency. I again continued to work as a physician in Panama and prepared for another year. On my second attempt, I passed with a very good score that qualified me to practice Radiology in Barcelona. I went on to study radiology at Hospital Universitari de Bellvitge (Bellvitge University Hospital).”

How do Spanish citizens become physicians in Spain?

“After preparing for university, students complete the Evaluación del Bachillerato para el Accesso a la Universidad/Baccalaureate Assessment for University Access (EBAU). The exam consists of multiple-choice questions with topics in biology, chemistry, physics, and mathematics. Students’ baccalaureate grades and EBAU scores are combined to create an admissions score; higher admissions scores (> 12.5/14) are considered competitive and will likely admit a student to a prestigious public university. After completing the six-year medical program, students complete the MIR Exam and begin medical residency.”

How do Spanish physicians apply for fellowships?

“A general radiology residency takes four years to complete. Afterwards, physicians compete for fellowship positions through Sociedad Española de Radiología Vascular e Intervencionista/Spanish Society of Vascular and Interventional Radiology (SERVEI). There are around ten fellowship spots nationwide for Interventional Radiology. You compete by gaining points proportionate to the degree of involvement you have in Interventional Radiology throughout your residency."

"For example, a physician may gain points by completing additional rotations in Interventional Radiology, publishing papers or presenting posters on Interventional Radiology, going to conferences for Interventional Radiology, or completing external or international rotations in Interventional Radiology. Depending on your score, physicians may be offered a one-year fellowship.”

How do Spanish physicians become board-certified?

“Board certifications will differ based on specialty. For Interventional Radiology, there is the European Board of Interventional Radiology (EBIR). Personally, I was approved in October of 2024. The EBIR is a very tough examination. To qualify for the EBIR, physicians must have completed an Interventional Radiology Fellowship and have two years of experience with a certain number of procedures as the first operator. The EBIR is a five-hour exam consisting of a clinical case scenario examination and a general clinical practice examination. If a physician passes the exam, they are certified as an Interventional Radiologist and may practice elsewhere in Europe.”

In Summary

The path to becoming a licensed physician in Spanish-speaking countries differs greatly from that seen in the United States. First, Spanish-speaking countries have a combined six-year medical program rather than four years of undergraduate studies followed by four years of medical school.

Second, acquiring a residency and fellowship is based on a medical student’s national ranking. This score is comprised of medical school grades, MIR Exam scores, and involvement with the desired specialty. This process varies from American residency placement, which occurs through the National Resident Matching Program’s “matching algorithm.” While the process of becoming a physician may be different in each country, the end result allows for all students to become physicians and begin helping their community.

About the Author

Aleasia Arnold is a second-year medical student at the Marian University Tom and Julie Wood College of Osteopathic Medicine. Aleasia is passionate about international travel and experiencing the different cultures of the world. Her interests span from increasing rural healthcare access to promoting nutrition and physical fitness education. She plans to pursue a career in Dermatology or Allergy/Immunology.