Humming the famous song by Roberto Carlos the other day, it is possible to apply its beautiful title to some of the “events” we see in the health system today, consequences of decisions as old as music itself. Let's talk about some.
In addition to recommending that any regional government stop bleeding uselessly, it must be said that Continuing care is a topic under debate at an international level. In Spain, since the reform of primary care, the establishment of Primary Care Teams and support for continued care, as set out in Annex II of RD1030/2006 of the SNS Services Portfolio. This is very good, but its development and operation is absolutely heterogeneous in Spain.
For the unread – and those who should be – I suggest keep an eye on some documents from the Ministry of Health from 2009 and 2015, with the name, not by chance, of extra-hospital emergency. What is there to do? A calm debate, outside the electoral period, agreed and led by Health, which allows delimiting and providing normative support, for example, to the role of nursing. It seems reasonable that it should not be left out of the update of the 2019 Basic Care Plan, presented by the President of the Government himself at the end of 2021.
This action includes so-called rural care, care in places that are difficult to cover, etc. The rural attention given by the SAR in the Community of Madrid was quite reasonable and with great citizen satisfaction. It is important to add that this is not a trivial issue, as residents have/we have the damn habit of not responding to a medical problem at the hours it should be, from 8 am to 3 pm on weekdays, in addition to not knowing what is happening to us and limiting our criterion of need for attention, which is how not a few monoscientists with decision-making capacity and longitudinal theorists of the thing think and believe it should be.
The alleged lack of doctors
The next “detail” under discussion. The alleged lack of doctors. You have to start by saying that Spain is one of the places with the highest number of medical schools in the world. And keep reporting that lCitizens pay 65% of their taxes for each medical student at a public university and 100% of their residency period. The latter, with an average of 4 or 5 years of residence, suppose 200,000 euros per place. In other words, between the two periods, at least eleven years, a fortune. To mean, Spanish society realized years ago that it had to invest a lot of money in these elite cadres.
The second part comes later: the disdain and mistreatment in terms of recognition and working conditions and remuneration in Spain of already trained specialists, both in the public and private sectors, with some exceptions. Of course, there has been a flight of professionals (including nursing professionals) out of Spain, and it goes beyond that.
Why? In this case, because Political leaders and societies in other countries generously appreciate in terms of treatment and conditions the enormous investment that Spaniards make in these qualified personnel. in which they did not have to invest anything in their training. A bargain, come on. Although some have not discovered it, we have lived for years in a globalized world, and the competition is international, not national. It is necessary to criticize medical training in Spain, also, among other reasons, for having omitted the teaching of abstract divination skills to those who will be future doctors and knowing what happens to patients without seeing or touching them. You have to fix this, given what has been heard these days. It is true that many doctors are graduating in Spain, and it is true that they have increased in recent years, and the number of vacancies for specialized medical training should continue like this. The problem comes later.
retirements and escapes
Another important “detail” that reinforces the previous one. There is a deficit, and there will be an alarming deficit, within the scope of the upcoming reforms, especially of family doctors and urgent and emergency doctors. This is not what I say. We can suggest reading, for better or worse, the latest report by Beatriz Valcarcel and the Health Economics team at the University of Las Palmas, a continuation of those published in 2011. In the case of family doctors, it must be said that it gives a paradox, a consequence, in part, of accumulated errors.
In recent years there are impressive percentages of “escape” from health centers by residents who finish their internship (minimum 70%), in Madrid yes, and in most communities. To explain this, in addition to what has already been commented, it is necessary to briefly recall the story again. Between 2002 and 2003, several of the most important healthcare laws were published in Spain: Patient Autonomy Law, Cohesion Law, Framework Statute Law and Health Professions Law.
No Emergency Medicine specialty
Limiting itself to the latter, and this is the responsibility of the Ministry of Health, It is inconceivable that it will continue without regulationwith its translation into profiles in “opes” and the like, the endless number of diplomas, subspecialties and accreditation specialties that actually exist and are missing. One of them, the Emergency Medicine Specialty. The reasons respond to the interests of a few, apart from the general interest, together with the exaggerated and non-neutral performance of intermediate positions, within today in Health, specifically in the General Directorate of Professional Organization. In short, as those responsible for practically all ministries and the real professional world report: It was not and will be impossible to plan anything in human resources in primary care or in the urgency and emergency system if this specialty is not created. If we add to this the error of having literally brought together different professions, such as doctors, in the Framework Statute, we have another additional reason that explains the very high temporary rates of these qualified personnel, and what is another reason to flee outside of Spain. In my opinion, there should be fewer doctors, but they should be much better paid and promoted, and there should be a great development of other health profiles that perform functions that doctors should not perform.
In conclusion, In Spain we must decide, as a society, what we want to be when we grow up. Ready and consistent with the investment we make; or “stupid” (or generous) to other countries like we are. Small “detail” that will mark the future of Spanish healthcare. We will see.
