An adequate and well-distributed medical workforce is a prerequisite for accessible, high-quality care, particularly as population ageing and multimorbidity increase demand for longitudinal management in primary care. Recent global reassessments also underline that persistent health-workforce shortages and maldistribution remain a material constraint on progress towards universal health coverage in many settings (Boniol et al., 2022[1]). Evidence from Brazil’s Programa Mais Médicos shows that deployment policies can rapidly expand physician supply in underserved areas, but also that short-term provision alone cannot substitute for structural workforce planning. National analyses suggest that sustainability depends on alignment with training capacity, regulatory frameworks and retention policies; while health gains were greater where baseline physician density was lower, the overall evidence underlines the need to pair deployment initiatives with broader primary-care system strengthening (Hone et al., 2020[2]; Pinto Junior, Amorim and Aquino, 2020[3]).
Doctor density varies markedly across Latin America and the Caribbean, ranging from around 9.5 doctors per 1 000 population in Cuba to 0.3 in Haiti, a more than 30‑fold difference (Figure 8.1). On average, the LAC33 has 2.4 doctors per 1 000 population, compared with 3.6 in the OECD. Several countries are at or above the OECD average (e.g. Argentina 5.1; Uruguay 4.7), whereas a number of countries report fewer than 1 doctor per 1 000 (e.g. Honduras 0.5; Jamaica 0.5; Nicaragua 0.7). While part of the cross-country variation reflects differences in education capacity and retention, it also reflects definitional differences in whether data capture practising doctors or all licensed physicians.
Women account for roughly half of physicians in the countries with available data, with an average of 50.9% in LAC18 compared with 49.5% in the OECD (Figure 8.2). The share is highest in the Dominican Republic (72.0%) and Peru (64.6%), while Mexico reports a lower share (43.9%). A more gender-balanced physician workforce has implications for training pathways and employment conditions, as specialty choice and working-time patterns may differ on average by gender, affecting full-time equivalent supply. However, a higher share of women in the workforce does not in itself ensure equity in career progression, leadership access or pay. Evidence from the broader health and care sector shows persistent gender pay gaps and occupational segregation, underlining the importance of pairing service‑level workforce planning with policies that promote fair remuneration and equitable career development (WHO, 2022[4]).
The age profile of physicians suggests heterogeneous replacement pressures. Across 14 LAC countries, 25.1% of physicians are aged 55 years or over on average, below the OECD average of 32.1% (Figure 8.3). Guatemala stands out with 46.8% of physicians aged 55+, followed by the Dominican Republic at 36.3%, while Paraguay reports 10.9%. Countries with an older physician workforce may face a near-term risk of retirements unless training inflows, retention policies and productivity improvements are strengthened.
These indicators point to three simultaneous planning challenges; (i) closing large cross-country gaps in physician density, (ii) adapting training and workplace policies to a near-parity (or majority-female) workforce, and (iii) anticipating retirements where physician populations are older – while protecting retention and productivity. Evidence from recent physician surveys shows how quickly retirement intentions can shift with workload and working conditions reinforcing the importance of proactive retention and work-environment strategies alongside training-pipeline measures. (Walsh et al., 2024[5]).
