Hi Mike
I have never heard of a company taking three years to get started, if a license has taken more than three years to get it is probably because it doesn't comply with regulations or has entered into what they call "administrative silence" meaning if they take more than 6 months to turn down the licence it is granted by default. I am aware of this within the Restaurant/leisure trade however with medical practitioners I have no idea... but the law is the law unless there is someone trying to delay the license to avoid competition, which isn't unheard.
As far as setting upa company, I agree it can be a pain and far more costly than other countries but you should have a limited compnay registered in approx 30 - 45 days. It's not fast by any means, especially compared to the UK and others where it can be up and running in the same day, but then VAT applications can take much longer too. With a Spanish SL, you are automatically registered for IVA as there is virtually nothing that doesn't carry IVA here!
It could be much better and much cheaper to set up here in Spain, you need approx 800 - 900 euros for administrative costs and 3000euros in share capital to start a limited company, obstacles that stop many ligitimate projects from going ahead, or force people to find alternative routes through Socidedades Civiles or Communidades de Bienes which do not have limited liability but are much cheaper to set up.
Moe importantly there are no tax relief programmes fro new companies something that Spain really needs to consider if it want to reduce its black economy and boost entreprenuers.
BTW I had no idea it was the third worst country to set up a company, what is it measured on? Financing capability? bureaucracy? Cost? Time? or all of them?!
Ian