The generation of conceptual, legislative, organisational and management instruments for health sciences specialties in Spain involves a wide range of stakeholders with competences in the aforementioned areas, the most significant being the state and regional health and education authorities, scholarly societies and various professional organisations. The visions and interests of these and other leading players regarding the problems affecting the development of specialties and specialists often do not coincide (and may even contradict each other). This can give rise to institutional conflicts that curb the implementation of innovation projects needed to ensure the system is adapted as well as possible to the accelerated evolution of scientific-technical knowledge and the repercussions this can have on both the creation of new specialties and the planning of staffing needs in each of them and on the changes required by their training programmes and competence assessment, to give but a few examples of common issues in this field.

In addition to the aforementioned problems we could add two others, intended merely as examples, which significantly condition the development of specialties in Spain (and in other countries). The first concerns the insufficient resources devoted by institutions to a field that is of such relevance in defining the quality of health care for the population. The second involves the proliferation of initiatives and projects designed by individuals and groups without the necessary competence in this field, in which professionalism is clearly lacking, and who, with the best intentions, can be defined as ‘amateurs’ in a field of the complex problems that must be solved in order to achieve an efficient and effective development of health sciences specialties. To complicate matters further, in Spain, the absence of a cross-cutting vision of both the health and the education authorities when it comes to addressing everything related to the planning and training of professionals working in the health sciences is obvious and public knowledge, with its origin in a seriously deficient institutional communication between the two governmental components. This fact is also a source of problems when designing a transition between the undergraduate degree and specialised training that guarantees an effective and cohesive educational continuum between these two essential phases of medical education and eliminates the negative effects that the current MIR exam has on the development of the degree, especially in its clinical stage.

It is obvious that the problems affecting the development of health science specialties in Spain are not limited to what has been said so far. They may, however, be sufficient to demonstrate the need to change the current deficient situation through the creation of an independent body of experts with professional leadership and prestige recognised by the stakeholders we mentioned at the beginning, and which has the necessary resources to respond to the increasingly urgent need for innovation in the health sciences specialties. It may be an agency, a consortium or some other type of body that, within the possibilities offered by the legal framework in our country, is able to establish effective relations with the authorities and the scientific and professional organisations. The combination of a sound legal framework for the creation of the body and the deep respect that its leaders and professionals must have for the stakeholders involved has to be the solid foundation, the starting point, of a successful trajectory [¹].

What we definitely cannot afford is to continue as we have been doing up until now, looking on with more or less indifference as the problems gradually pile up in the field of health science specialties. Swift determined action is needed to provide workable solutions before it is too late. The creation of an expert agency can make a positive contribution to finding rational solutions adapted to the context of our cultural and health systems.