The specialized medical training system known as the MIR (“Medical Intern Resident” program) is the pathway established to pursue accreditation in a medical specialty in Spain. To secure a residency spot, candidates must take a single national exam, which accounts for 90% of the final admission grade and is combined with the grade point average of their undergraduate medical degree, which accounts for the remaining 10%. In each annual application cycle, candidates choose a specialty based on their ranking, and therefore this selection process indirectly reflects the appeal and interest that each specialty holds for future specialists. Specialty training takes place at accredited centers over a period of 4–5 years, depending on the specialty; in the case of pediatrics, it lasts 4 years.

The objective of our study was to describe trends in the selection of residency spots in pediatrics after the MIR exam over the past 15 years (2010–2025).

To this end, we designed an observational descriptive study of the selection of pediatrics residency spots in the annual medical specialty residency application cycles between 2010 and 2025. We excluded spots at the Clínica Universidad de Navarra because, during part of the study period, the selection process for those spots was based on specific requirements established by the institution.

In the 2010–2025 period, a total of 7096 pediatric residency positions were offered over 16 application cycles. In 2010, there were 406 pediatrics spots out of a total of 6799 MIR spots, while in 2025, there were 516 out of a total of 9007 spots. There was a 27.1% increase in the number of available pediatrics residency spots, while the total number of MIR spots increased by 24.5%. During the same period, the last available pediatrics spot was awarded to the candidate ranked at the 3818th position in 2010, compared to the candidate at the 5283rd position in 2025, which corresponds to a 38.4% increase in the ranking position of the candidate selecting the last available pediatrics spot.

As for the choices made by the top-ranked candidates in each application cycle, in 2010, 13 of the top 100 candidates chose pediatrics as their specialty (ranked at positions 5, 7, 13, 17, 21, 33, 35, 50, 55, 56, 60, 68, 92), in addition to 61 of the top 500, and 126 of the top 1000. In contrast, in 2025, only 1 of the top 100 (ranked at position 86), 8 of the top 500, and 37 of the top 1000 chose pediatrics. Fig. 1 shows the trends in the selection of pediatrics spots in each application cycle among the top 1000 candidates.

Figure 1.

Number of pediatrics residency spots selected by among the top 1000 candidates in each application cycle.

To complete the study, we selected the ten hospitals in Spain that offered the largest numbers of pediatric residency spots. Table 1 shows the ranking position of the last spot offered at each of these hospitals in the different application cycles. In all of these hospitals, these spots were filled with candidates with larger ranking positions in 2025 compared to 2010, with increases in position number ranging from 28.6% to 763.5%. The largest increases occurred in the hospitals whose spots filled out earliest in 2010, such as Hospital 12 de Octubre.

Based on the collected data, it appears that the specialty of pediatrics has become less appealing to MIR candidates. The reasons are probably multifactorial and may be common to several medical specialties with similar characteristics. As a hypothesis, we propose five possible causes, whose actual significance we intend to analyze soon by surveying MIR candidates to effectively determine the reasons behind this trend:

• 1

  The increasing hardship of on-call shifts, which in the case of hospital-based emergency care entail 24-h shifts with hardly any time to rest.1

• 2

  The increasing frequency of conflicts and acts of aggression, which are more common in specialties that involve greater interaction with patients and families and in the primary care setting.2

• 3

  The lack of recognition of pediatric subspecialties or specific training areas, combined with the increasingly widespread requirement to extend training for a fifth year—which is neither officially recognized nor compensated by the National Health System.3

• 4

  The progressive deterioration of working conditions in primary care, where most pediatricians work.4,5

• 5

  Career opportunities in private health care that, in the case of pediatrics, do not seem to significantly improve the working conditions offered by the public health care system.

In conclusion, we must identify and address the underlying causes of this trend in order to reverse it and restore the appeal of pediatrics as a specialty training option. If no measures are taken, there is a risk that spots in this specialty will be left unfilled in future application cycles.