Healthcare managers in the Madrid region are resigning over plans to privatise part of the health service in and around the Spanish capital.
The regional government wants to cut costs by privatising the management of 27 health centres, out of 270 in total.
On Tuesday 322 managers from more than half of the centres tendered their resignations, to take effect when the privatisation takes place.
Spain's debt crisis has brought deep cuts to public healthcare.
The country's 17 semi-autonomous regions administer healthcare and education.
On Monday thousands of Spanish medical workers and residents marched through Madrid, angry at the conservative regional government's privatisation plans.