IESS Has Hundreds of Extra Doctors — But 13,000 Patients Are Still Waiting for Surgery

The Paradox at the Heart of Ecuador's Public Healthcare

Here's a head-scratcher: Ecuador's social security health system (IESS) has hundreds of medical positions classified as "excess" — meaning more doctors than they need. At the same time, 13,354 patients have been waiting more than 90 days for surgery.

If you use IESS healthcare in Cuenca, this directly affects you.

The Numbers Tell the Story

The staffing surplus breaks down like this:

Facility Type	Excess Positions
Specialty Hospitals (Level III)	715
General Hospitals	365
Ambulatory Surgical Centers	314
Specialty Centers	239

That's over 1,600 positions classified as excess nationwide. And yet operating rooms are shutting down because they can't find the right specialists.

The Problem: Wrong Doctors in the Wrong Places

IESS has plenty of general practitioners filling hospital roles. What they're critically short on:

• Anesthesiologists — you literally can't do surgery without them
• Nursing staff — not enough surgical nurses
• Ambulance drivers — emergency response gaps
• Surgical subspecialists — the complex cases keep piling up

The result? The Carlos Andrade Marín Hospital alone had 3,582 pending operations as of September 2025.

What This Means for Cuenca

Cuenca's main IESS facility, the José Carrasco Arteaga Hospital (the Level III hospital on Avenida Rayoloma), faces its own version of this crisis:

• Missing: Clinical oncologists, hematologists, biomedical technicians
• Under review: Security personnel (outsourced services being evaluated)

If you need cancer care or blood disorder treatment through IESS in Cuenca, you may face longer waits or referrals to Quito or Guayaquil — neither of which is convenient.

The Medication Problem Is Even Worse

Beyond staffing, IESS medication supply has dropped to just 55% nationally. That means nearly half the medications that should be available at IESS pharmacies simply aren't there.

The system is pursuing emergency purchases for 193 drugs and 922 medical devices, but procurement takes time.

What IESS Is Doing About It

Officials approved an "Optimization and Rationalization Plan" that includes:

1. Internal transfers — moving excess doctors to understaffed areas
2. Hiring freezes in overstaffed units
3. Position eliminations if transfers don't work

As one physician put it: "The problem isn't just money, it's management."

Practical Tips for Expats Using IESS

• Don't wait for emergencies. If you need a specialist referral, start the process now. Wait times are measured in months, not weeks.
• Keep your IESS payments current. You need 6 consecutive months of contributions to access most services.
• Have a backup plan. Many expats maintain both IESS and private health insurance. Given the medication shortages and specialist gaps, a private option for urgent needs is worth considering.
• Check medication availability before your appointment. Ask the pharmacy what's in stock so you're not surprised when your prescription can't be filled.
• Consider Cuenca's private hospitals for time-sensitive procedures: Hospital del Río, Monte Sinaí, and Clínica Santa Ana are all well-regarded options.

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Sources: Primicias, IESS