A senior Panama health official has provided a detailed breakdown of the country’s medical training process, clarifying common public confusion while issuing a stark warning about a growing oversupply of general practitioners. Paulino Vigil De Gracia, the national director of Teaching and Research for the Caja de Seguro Social (CSS), explained the distinct stages from student to specialist in an exclusive interview. He simultaneously cautioned that the system is producing more doctors than it can effectively absorb, creating bottlenecks and employment challenges.
The clarification comes amid ongoing public debate about healthcare quality, hospital overcrowding, and the roles of different medical professionals within Panama’s public institutions. Vigil De Gracia’s explanation serves to demystify the progression that every Panamanian doctor must follow, a path he says is often misunderstood by both patients and students alike.
“The student finishes six years in the faculty of Medicine and receives their university diploma, but they are still not a fully qualified doctor. That step is necessary to continue the career, but mandatory practical training is still missing,” explained the CSS official. [Translated from Spanish]
He emphasized that a university diploma labeled “doctor of medicine” marks only the end of academic studies. It does not legally or professionally authorize the graduate to practice independently. The crucial next phase is a two-year medical internship performed in public system hospitals under the direct supervision of specialist tutors.
The Structured Path to Becoming a Doctor
During the internship, trainees integrate theoretical knowledge with direct patient care while being closely monitored. Vigil De Gracia described interns as vital components of the health system’s machinery. They provide significant help and perform work, but they are not yet fully qualified and must remain under supervision at all times. He identified a current strain, noting the number of interns now exceeds the real capacity of available tutors in teaching hospitals.
Completion of the two-year internship leads to diplomas issued by the CSS and the Ministry of Health (Panama). With those documents and the original university title, the graduate can then approach the Consejo Técnico de Salud. This entity certifies professional competency. Only after this certification, Vigil De Gracia clarified, does the individual formally become a general practitioner.
“The general practitioner is now qualified. They can work in either the public or private sector and are trained to resolve a large portion of the population’s health problems,” he stated. [Translated from Spanish]
Aspirations for specialization can begin from this point. The general doctor must compete for a placement to enter a medical residency program. This intensive training occurs in a teaching hospital under specialist guidance and lasts between three and several years depending on the chosen field. A general practitioner entering a pediatrics residency, for example, requires three additional years of formation before becoming a pediatrician.
The complete journey follows a strictly defined sequence: medical student, medical intern, general practitioner, medical resident, and finally, specialist. Each stage is indispensable. Omitting any step would directly affect the quality of healthcare, according to the experts.
System Strain and a Specialist Shortage
Beyond the technical explanation, Vigil De Gracia delivered a pointed warning about the current state of medical training. He acknowledged Panama trains good doctors but alerted the public to a critical imbalance. The system is graduating more professionals than it can accommodate, particularly at the general practitioner level.
“We are training more doctors than we need. This is generating a serious problem, especially in the medical internship, because all graduates require those two mandatory years and we do not have sufficient capacity,” he said. [Translated from Spanish]
This oversupply has led to a worrying reality featuring unemployed or underemployed general practitioners, some working under inadequate conditions. In his judgment, the country’s real deficit is not with generalists but with specialists. The true pressure point lies in specialist training, an area where Panama desperately needs more professionals. This shortage directly impacts the integration of the health system and overloads high-complexity hospitals.
The official stressed the urgent need to strengthen primary healthcare as a fundamental pillar. A robust primary care network could reduce pressure on specialists and improve overall system efficiency. He praised the work of primary care physicians, whether generalists or specialists in family medicine, as essential for a sustainable health model. This call for systemic adjustment aligns with broader governmental efforts to optimize public services, similar to initiatives in other sectors overseen by a Director Nacional.
Vigil De Gracia’s comments highlight a pivotal crossroads for Panama’s healthcare education. The nation has established a clear and rigorous path for creating competent physicians. Now it faces the logistical and planning challenge of aligning the number of graduates with the system’s practical training capacity and ultimate employment needs. The solution, he implies, requires coordinated action between universities, the Ministry of Health, and the CSS to balance output with demand and prioritize filling the specialist gap.