Little “flexibility” of the SNS, more doctors specialize outside

More and more new doctors are leaving Spain after graduating in search of an alternative to MIR training offered by the National Health System (SNS). Or at least that’s what they say from the Association of Spanish Doctors in Europe, an organization that is in charge of advising doctors interested in completing their training outside Spanish borders and that is increasingly receiving more demand for information. Alejandro Barrospresident of said association, argues that recent graduates are not attracted to the process involved in doing the MIR, for which “a number” determines your future. Thus, one of the main reasons why they decide to pack their bags and leave Spain is the lack of “flexibility” that the National Health System has.

Barros is one of the new doctors who chose to leave Spain and embark on specialization in another European country. “Since the beginning of the fifth year of the race, he knew that I was not going to do the MIR because I was not interested, especially seeing how the system was structured”, he stresses in conversation with Medical Writing. A system, he argues, in a “funnel”, with lack of “flexibility” and “terrible” conditions labor.

From the association he founded, Barros sees that week after week more and more young doctors are considering specializing outside of Spain. Alexander Mauri He is another of them, who will not only do his specialty outside of Spain, but has also completed his university degree abroad; in Budapest (Hungary), specifically. This very week he will leave for Germany to begin his specialization in Traumatology to later do the subspecialization in Sports Medicine, although in a talk with this newspaper, he stresses that all the bureaucracy of putting all the papers in order will take him “one or two months” before he can start this specialized training. “In Germany you can start whenever you want, in the hospital you want, in the city you want and in the specialty you want, as long as you have the documentation in order and there are offers”, he comments, praising the “flexibility” of the German healthcare system.

“I was already having another route to the Spanish MIR system in mind. I went to study abroad. And in a more international environment you are thinking of continuing to grow abroad. I finished my degree in Budapest and the option for Germany came up, so that’s where I’m going”, explains Mauri.

Working conditions, the main reason

“In 2020 I made an attempt to return to Granada and I worked there for a year, but the truth is that I lost my desire and in January 2022 I returned to Germany”, says Belen Barrera, a Spanish doctor who has been in the Teutonic country for more than a decade. After graduating from the University of Granada, he went to Germany to do a doctorate and specialize in Internal Medicine first and in emergencies after. Now, after that short journey through Spanish health, he continues to work in Germany.

Like her, there are several health professionals who choose to do the specialty in Europe. From the Association of Spanish Doctors in Europe they affirm that, to this day, they have close to a hundred associates. They fix on the flexibility and vocation the two main reasons for the ‘fleeing of white coats’ from Spain: “That the doctor dedicates himself to the specialty he wants is a compelling reason in the final decision of the students, in addition to the economic conditions”, they emphasize.

“If you have a greater economic incentive and a right to make mistakes and rectify, help in decision making. And that is what I think Spain lacks a bit”, details Alejandro Mauri. Some “deficiencies” that the new doctors do not see solved or covered in the National Health System, and that due to this, some opt for not integrate into the system Spanish toilet.

A “great” national reform, possible solution

The duration of employment contracts is one of the handicaps of new professionals. Barrera, from his experience in the Spanish system, denounces that it is unfeasible to cover care and structural positions with temporary contracts of “thirteen days”. In turn, he points out that on that last day of the temporary contract, the doctors do not know if the next day they will have to return to the hospital to work for a position that “must be filled.” Yes or yes”. “It does not seem to me a problem of lack of budget, it is management and political will. There are many ugly towards the professional that they have nothing to do with money, that it is a matter of mentality and wanting to stay in the system”, argues the doctor.

One of the premises pointed out by the Association of Spanish Doctors in Europe is the lack of update of the system. They believe that it is one of the reasons why health workers decide to leave their country in search of a system that can provide them with more. “What worked before has stopped working. In Spain you cannot take a step without first having taken and passed an exam”, criticizes Barros.

That is why these doctors, who in the not too distant future would like to “return to Spain”, are calling for a national “great reform” to be carried out, “from above”, in order to solve the problems that they believe the SNS accumulates. Reform the allocation of places and opening more hospitals are two ways that Mauri proposes to improve the Spanish system, to which he adds that it would “help” if people were entitled to good conditions.

“Doing an opposition to get a job… that’s what kill the system Spanish, added to the working conditions”, ditch Alejandro Barros.