Doctors who work in public and private: 2 CCAAs veto it

Although under certain conditions, the vast majority of the autonomous communities already allow health workers work simultaneously in the public and private spheres. In Spain there are only two exceptions, according to the sources consulted by Medical Writing: Navarre Y Asturiaswho maintain the exclusive dedication of the professionals who exercise in direct management services.

Until just a few days ago I was also part of this group Galicia. However, the Xunta has already announced its intention to make the model more flexible so that doctors, nurses and other health personnel can reconcile their public function with their private. Sources from the Galician Health Service (Sergas) point out in this sense that the work has begun hand in hand with medical colleges Of the territory.

The new instruction of the Galician Government thus opens the door to the compatibility of toilets for carry out a public and a private activity “regardless of whether or not it is carried out in a center that has some contractual link with Sergas”.

A “much more flexible” modelmaintain these sources, which also contemplates a system to verify that “with this activity in the private center, the health professional does not treat a patient who has already been treated in public health for the same pathological process.”

In fact, the vision of the requirement of exclusivity has changed throughout the last decades by the Administration and the different health groups, including the physician, hand in hand with the health reality, the situation of professionals and professional culture and the situation of the health services market. So much so that removing exclusivity has been a Formula to retain and retain professionals “at a time of high competition for the attraction of doctors,” some sources maintain.

Autonomous laws for public-private compatibility

Most of the autonomous communities regulate this public-private work of health professionals through the Law 53/1984 of incompatibilities of the personnel at the service of the Public Administrations; although some ministries contemplate regulations at the regional level. This is the case, among others, of Castilla y León, which in 1997 gave the green light to its own regulation. In 2018, the Ministry of the Presidency also approved a order to regulate the authorization procedure of said compatibility.

For its part, in the Balearic Islands “compatibility is allowed whenever it is requested from the Health Service and authorized. “Other autonomies, such as the Valencian Community or Murcia, include other exceptions that prevent the simultaneous exercise in public health services and in the mutuals of officials such as Isfas, Mugeju or Muface.

In any case, any case of compatibility must have the approval of the council in question, sentence the councils.

Exclusivity in Navarra and Asturias

The communities of Navarra and Asturias remain on the sidelines, the only ones that currently maintain the exclusivity of working in the public sphere for professionals from the regional health services.

However, government sources consulted by Medical Writing They do not rule out that this circumstance may change in the future. “In the negotiation that is being held with the Medical Union, as well as through dialogue with the different social and professional agents, It is proposed to eliminate this regime”, they qualify from the Department of Health of Navarre. The regulations in force in this regard are Law 11/92 of October 20, regulating the specific regime for personnel assigned to the Navarre Health Service-Osasunbidea (SNS-O). Finally, they advance that it is already “promote a bill in the Provincial Parliament” to go down this road.

According to the latest data, 42 of some 2,300 SNS-O professionals they don’t get the exclusivity plugin right now, so somehow this regulation “penalizes” them. In addition, the proposal of the Department of Health proposes the maintenance of the exclusivity regime for heads of Service due to the level of responsibility carried out, with management of complex services at the level of personnel, patients and technology, an availability and a commitment that, on the other hand, , plans to encourage in the measures presented with a increase in the remuneration complement of those heads.

Finally, from Asturias, sources from the regional health service state that no changes regarding this exclusivity. “When you want to work in the private sector, you ask for the resignation of the specific complement,” they point out. In addition, sources from the Health Service of the Principality of Asturias (Sespa) point out that in this way commitment to “quality public health”.