“There is no lack of doctors; there is a lack of specialists in family medicine” in Palencia
Thirty-five patients per day, with an average consultation time of ten minutes and a maximum period of no more than two days. These are the pillars on which the agreement signed between the Ministry of Health and the Cesm medical union is based and which represents a starting point to continue negotiating in the coming months on aspects such as the de-bureaucratization of Primary Care and establishing improvements in the hospital setting.
The document is a shock measure in the face of the deficit of professionals, and defends “at all costs” that the medical act be face-to-face, which entails the articulation again of the opening of clinics in the afternoons on a voluntary and paid basis. In this way, according to this approved agreement, Family doctors will attend to a maximum of 35 patients a day, of which 25 will be in person, with an average time assigned of ten minutes, an “ancestral claim” of the group. In addition, they will make an appointment in a maximum of 48 hours, and there will be another ten appointments that will be distributed at the discretion of the professional, preferably in person, but also by telephone.
And although it seems that they are measures applauded by all levels, however, the underlying problem in Primary Care is more substantial. The president of the College of Physicians of Palencia, Francisco José del Riego Tomás, denied, in statements to Diario Palentino, that there is currently a lack of doctors. «There is no shortage of doctors; what is missing are specialists in family and community medicine. There are not enough MIR places for this very important specialty and, nevertheless, we have a higher ratio in others”. The ratio of active doctors per 100,000 inhabitants in Palencia was 414 in 2022, while the regional average is 451.
Abounding in the data provided by the College of Palencia, in 2022 the number of family doctors in the province per 100,000 inhabitants was 128 (136 in 2019). In fact, the replacement rate in this specialty is 0.68, below reference 1, which would be the essential minimum. The regional mean was established in 2022 at 119 family medicine physicians (with a replacement rate of 0.99).
REPORT IN THE COURTS. Francisco José del Riego wanted to use data to analyze the current situation, which was expected taking into account that the Official Council of Medical Associations of Castilla y León already presented in 2019 in the regional courts a demographic study with analysis and trends on reality at the community level, a report that was monitored again in 2022.
One of the conclusions of the aforementioned report is that the number of active doctors was lower in 2022 than three years earlier and that the number of doctors per inhabitant, province and specialty was not homogeneous, an issue that already called into question equity in access to public health care. “More than a general lack of doctors, which does exist in some specialties, there is an irregular distribution not based on objective data,” he indicates.
On the other hand, the report presented before the Courts indicated that the age distribution of the total active doctors in the province and in the community in general takes the form of an inverted pyramid. In fact, the number of active physicians over 65 years of age has doubled in the last three years, from 5 to 11 percent. And, what has been previously commented, the rate of replacement of specialists is highly variable depending on the specialty; In some, this index is good and in others it is deficient (psychiatry, digestive system and general surgery, oral and maxillofacial surgery, microbiology, otorhinolaryngology, clinical analysis, geriatrics, family and community medicine, allergology, preventive medicine and occupational medicine, for this reason). order).
Likewise, the deficit of doctors is manifested in a singular way in family and community medicine which, due to its volume and importance, (represents 27% of active doctors), is the gateway to the health system and already has a serious shortage of troops) has a serious impact on the health system globally. In fact, a high percentage of family doctors, according to the president of the College of Physicians, “carry out their work in hospital emergencies, a circumstance that has not been taken into account in planning, which aggravates the replacement of first-level doctors care».
It indicates that “it is necessary to analyze and provide solutions to the specialty with measures that not only go through increasing MIR positions.” In line, Francisco José del Riego was “totally in favor” of the creation of the Emergency specialty, not only because of its professional characteristics but precisely because of the high occupation of family doctor positions in his departments.
The president of the College of Physicians of Palencia, like the rest of his counterparts from the other provinces of Castilla y León, called for a pact for health to make the system viable and the creation of a new human resources management plan.
COMPLAINT. On the other hand, Francisco José del Riego also confirmed that “complaints” have arrived at the College in recent months for allegedly irregular hiring in Primary Care. In fact, on Monday it came to light that the Community Prosecutor’s Office had opened proceedings to clarify the facts reported in the complaint filed by a doctor who practiced at the Guardo health center for an alleged irregular hiring of family doctors in centers Community Primary Care, specifically 120.
Francisco José del Riego pointed out in this regard that he was unaware of the substance of the matter but stressed and recalled that the Council of Ministers approved in September 2020 a Royal Decree-Law of Measures that allowed the autonomous communities and the National Institute of Health Management (Ingesa) the exceptional hiring of medical and non-medical personnel to deal with the health crisis caused by covid-19, thus enabling the incorporation of 10,000 health professionals.
Specifically, the text included the possibility that professionals who had the corresponding degree, degree or diploma could be hired, but who lacked the title of specialist recognized in Spain to carry out functions typical of a specialty.