2024-01-18 00:12:43
Those who present themselves this MIR Saturday will be the new batch of medical specialists of 2030. Almost 9,000 new professionals. Almost 2,500 of them are expected to choose the Family and Community Medicine option, because primary care needs to reinforce its forces. Because the foundations of the national health system are based on it, although its Labor conditions are not the most attractive: high workload, little time for patients and little professional training.
“I want us to feel pride in our public health again.” With this phrase Mnica García debuted in her position as Minister of Health, almost two months ago. One of the challenges facing her department is addressing the problems of primary care. To do this, she will convene a monographic Interterritorial Council at the end of the month to address it with the communities.
A path that former Minister Carolina Darias began in 2021 and that did not reap the expected fruits. In the middle of the pandemic, a meeting was called with the 17 CCAA in which the Strategic Framework for Primary and Community Care. A roadmap designed by the ministry of María Luisa Carcedo and agreed upon with the autonomous communities in April 2019, which was waiting in a drawer. The pandemic changed everything, yes. But it served to shed light on each problem in the system and amplified them. One of them, the needs of the first level of care, the primary care that It requires both economic and human resources.
Achieving the latter involves attracting them from the University. Thousands of students studying Medicine now face an exam that will mark the roadmap for their future specialization. Specifically, this year there are 8,772 places offered in the MIR 2024 call. Compared to the previous year, there are 222 more places, almost a 2.6% increase compared to the 2023 offer.
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The lack of family doctors becomes endemic: “Serving 50 people a day is crazy”
The lack of family doctors becomes endemic: “Serving 50 people a day is crazy”
The official offer, published in the Official State Gazette (BOE), states that the main increase focuses on the specialty of Family Medicine, which goes from 2,455 to 2,492. In absolute terms there are 37 more seats, but heThe teaching capacity of the system is close to the maximum: In June there were 2,525 accredited, so the maximum increase could have been only 70 places.
According to the Ministry of Health, these places were not offered due to technical issues such as the transfer of teachers to another center. It must be remembered that this specialty has been ending the MIR election with vacant places for two years in a row, despite the extraordinary call: there were 93 in 2022 and 131 in 2023.
It is worth remembering that Family Medicine is the specialty with the most offer, while it is the option with the most vacancies and a higher dropout rate, with an average of 45 places per year since records were published (2017-2018). Since then, 892 places have been abandoned, of which 225 belong to MFYC, that is, 25% given up belong to Family. The specialty will present a deficit of more than 10% by 2028, according to the report published by the Government in 2022.
“A critical situation”
The member of Young Doctors of the OMC, Domingo Sánchez, considers that “we are facing a critical situation in the Specialized Health Training model and in access to it.” For this reason he wonders “What plans does the ministry have to mitigate or work on this?”
Vicente Matas, coordinator of the Study Center of the Medical Union of Granada, simplifies the formula. “In primary care, which is the fundamental problem of lack of specialist doctors, right now you need budget, staff and time for patients.” Without an attractive job offer, students will always queue to choose other specialties.
Despite this, Matas values these increases in places that later remain empty. The way in which places are awarded also harms the specialty. At the same time, he explains the reasons. If one chooses Otorhinolaryngology, it does not matter if it is one hospital or another. But if you choose Family Medicine in Valladolid, for example, you may do your residency on the outskirts of the city. Choosing the first is not the same as choosing the last. Since, although one is assigned to a specific teaching unit, they may be assigned to a rural or more stressed area. And this is only known at the moment of accepting it.
The State Confederation of Medical Unions has also highlighted this obstacle. Its MIR spokesperson, Sheila Justo, explains, as reported by Diario Médico, that the fact that the assignment is not in real time makes the choice difficult especially in Family Medicine, because you cannot know the order in which you are when you choose the teaching unit. And he insists that being first is not the same as being last; You cannot choose the center through which the resident would be interested in rotating.
The WTO member emphasizes that this began with the telematics election. Now you leave with a list of priorities, but you may have forgotten a place or not taken it into account. But if you take it and don’t take it, it is rejected. You have to take a look at the system and do it in real time.
Matas points out a possible solution for the playoff. A second round with the rejected places, because otherwise those are irrecoverable and remain deserted. Until now, only the vacant places that are made available to examinees and later to non-EU professionals are occupied.
Another of the obstacles is the knowledge that is acquired in the residence. From the Primary Care Doctors Forum, concern about teaching has been expressed more than once. Although the Family Medicine training program is conceptually very advanced, the political decision of the Ministry of Health is needed for it to move forward and be prioritized. The last approved program is that of 2005 and it does not include chronicity, the approach to chronic non-oncological pain and other aspects that are the normal and daily scope of the family doctor. Primary care needs to have an updated program that reflects its reality, the forum emphasizes.
This is not a question of increasing places, it is not that simple, Sánchez emphasizes. The WTO member recalls that the head of the Executive, Pedro Sánchez, has mentioned it on several occasions as an achievement. But he insists that to cover them we must make them attractive, improve salaries… Because this system is the only way that guarantees the training of excellent professionals. And he emphasizes: This is not making screws, we are not a factory.
Matas remembers that the increases in places that have been taking place since 2019 will not bear fruit for a couple of years. We’re already late. We have the right templates. As soon as a partner is missing, vacations arrive… The system is already unbalanced and healthcare overload is triggered. In this sense, he insists that the one who suffers the consequences of poor planning is the patient, who is forced to go to the emergency room for issues that would be resolved at the health center. But also the system, because it is more expensive to treat a person from scratch in the emergency room of a hospital than by the family doctor who knows the patient and his problems, he emphasizes.
The most requested specialties
In the MIR 2023 call, the specialties that previously sold out their places at the beginning of the election shifts were: Dermatology (123 places), Plastic, Aesthetic and Reconstructive Surgery (55), Cardiology (197), Oral and Maxillofacial Surgery (35), Ophthalmology (220), Neurosurgery (53), Anesthesiology and Resuscitation (427), Orthopedic Surgery and Traumatology (286), Otorhinolaryngology (111) and Urology (139). The first two are traditionally the most desired and for which more candidates yearn.
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