Canarian healthcare is supported by a conglomerate of professionals who They work like a gear. From doctors, nurses and even laboratory assistants and technicians. They all play an indispensable role in caring for island patients. And yetthat Swiss watch that we look at with pride is still missing parts. In health care that since its conception has been focused on disease, health care has been relegated to the background. The same one in which there are a series of forgotten professions whose presence, however, could change the course of many pathologies, including those most prevalent in the Canary Islands.
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Psychologists, physiotherapists, nutritionists, occupational therapists and speech therapists have something in common: their representation in the health system is very poor. Although some have managed to gain a foothold in recent years, the situation is far from being ideal to respond to the needs of the population.
The reasons for this underrepresentation are diverse and depend on the profession in question. Given the growing mental health problems, the Ministry of Health has proposed to bring psychologists closer to the population by placing them in Primary Care – through the +AP Strategy -. However, the lack of professionals with specialized The recruitment of talent has stopped dead. Physiotherapists, although more than enough to meet the demand, are often forced to compete with a growing healthcare agreement that is governed by outdated regulations. Nutritionists, for their part, do not even enjoy recognition as health workers, so their figure is non-existent in the Canarian Health Service (SCS).
Despite the precarious situation, these specific professions are essential figures to safeguard the fragile health of the island population. Not in vain, The Canary Islands is the community where the most people suffer from mental health problems (31.1%), It is the one with the highest rates of obesity (18.1%) and diabetes (10.9%) in Europe and it is also where it is most difficult to access a consultation with a traumatologist, with an average delay that exceeds 200 days
Surrounding all of these diseases is a word that resonates but is rarely paid attention to: prevention. “The health system is reaching the majority of patients when the problem is already established,” explains Vanesa Eugenio Bermúdez, vice president of the College of Physiotherapists of the Canary Islands (COFC).. «It is a model that has a very important medical component, “Everything has been centralized,” agrees Tamara Cabrera, spokesperson for the board of the College of Psychologists of the province of Santa Cruz de Tenerife. And Aitor Monzón, president of the College of Nutritionists of the Canary Islands, also adds to this analysis, adding: “The health system prioritizes medicating before reversing.”
Time, the progressive aging of the population and the increase in chronicity and the impact of the pandemic have shown how inefficient a system designed to treat and not to prevent can be. And not only because of the harm to the patient but also because of the excessive spending on health resources that cause preventable diseases. All of this has led Spain to rethink its universal health model, including the Canary Islands, which is now looking for how to integrate health care into a system where the important thing is the disease that reaches the hospital.
A Strategy to make a difference
From there arises the Strategy to promote Primary Care in the Canary Islands, +AP Canarias. An action guide that was launched by the socialist counselor, Blas Trujillo, and whose precepts have been integrated during this legislature by the current nationalist Health Minister, Esther Monzón. The purpose of this document is to give prominence to health centers to turn them into sentinels of the disease, creating healthier environments thanks to this long-awaited prevention.
Almost three years after its accelerated implementation, psychology and physiotherapy professionals have begun to carve out a niche for themselves in the healthcare system. Especially in Primary Care, which is the place where they can make a difference. Today, according to data from the Ministry of Health, they are 116 physiotherapists and 42 psychologists those who work in the health centers of the Islands. If the professionals who also practice in the hospital setting are added, the total numbers rise to 474 and 174, respectively. Nutritionists – whose work the patients themselves are often replacing in Primary Care – are not, nor are they expected at the moment.
These very poor figures contrast with those of other professions. According to data from the Ministry of Health, in the health centers of In the Canary Islands there are 1,264 family doctors, 315 paediatricians, 1,432 nurses, 228 nursing assistants and 928 administrative assistants.
One step, but minimal
But even with the step forward that the incorporation of psychologists and physiotherapists into health centers has meant, both professions are still very underrepresented. “In principle there has been a minimal and very unequal distribution between islands,” acknowledges Bermúdez, who highlights that, even though the populations are very similar, there are “many more physiotherapy professionals in Tenerife than in Gran Canaria.” Specifically, those from Tenerife have more than 40 professionals and those from Gran Canaria do not reach twenty.
According to the vice president of the COFC, this is due to the fact that many health centers on the latter island are closed in the afternoon, which in her opinion represents a waste of resources, and to the important health care agreement with private centers. “We have facilities and in the Islands we have enough physiotherapists in the market to be able to double the staff,” defends Bermúdez. The objective is to have one physiotherapist per health center. “There are plenty of professionals, but they are leaving,” she warns.
In this sense, it highlights that public procurement can be cheaper and more effective than concerted procurement. “Concerts with private physiotherapy centers cost us 13 million euros, and doubling the workforce in public health would mean an investment of 8 million,” calculates Bermúdez, who also warns that the bases by which these concerts are governed are outdated. , since they have not been reviewed since 2013.
Psychologists find themselves in an even more precarious situation. In the Canary Islands it has only been possible to hire 39 psychologists for all Primary Care, which means that they are not found in all health centers or on all the Islands. At this moment there are only psychologists in Tenerife, Gran Canaria and La Palma. “We have taken a very important first step, but we are still far behind,” says Cabrera.
The incorporation of these toilets into the healthcare system has also not been without problems. And the professional profile that is authorized, in principle, to practice in public health is that of clinical psychologist. A specialty obtained from the Psychology residency, better known as PIR – acronym for Resident Internal Psychologist – and with which they usually practice in Mental Health Units (USM), the majority assigned to Psychiatry.
However, due to the few specialized training places offered by the Canary Islands (21 in total over four years), a provisional formula was enabled for attracting and retaining talent within health centers. Thus, to fill these newly created positions, health psychologists are being hired, who have a master’s degree that qualifies them to treat, among others, the most common mental disorders, such as anxiety or depression.
However, now the regional Executive is at a crossroads, because even opening its hand to hiring professionals who have different specialties, the labor market is so scarce that they are encountering difficulties in continuing to expand the workforce, as anticipated. in its plan to improve Primary Care.
What the +AP Strategy does not contemplate, at the moment is the incorporation of nutritionists, a profession as forgotten as it is necessary. And despite not having a single professional practicing in the health system, their functions are often replaced by nursing staff. “The autonomous community does not consider the nutrition professional as a health worker,” reveals Aitor Monzón. A circumstance that may be related to the youth of these studies in the Islands – this year the first university class will graduate – but that is already generating problems that professionals fear will become chronic.
This lack of recognition not only leaves professionals with no “gap” within the health system, it is also an incentive for labor intrusion to “ramp freely.” “As we do not place ourselves in the context of health regulations, it is not necessary to register, so it is not easy to control who does or does not have the qualification,” says Monzón. The latter also occurs in the case of occupational therapists.
At the same time, there is a paradox that in the hospitals of the Canary Islands There are 53 technicians in Dietetics and Nutrition – with higher education training – but no university graduate in Nutrition. “Right now our services are purely private and, for this reason, we often dedicate ourselves more to answering questions that seek to worship the body than to the disease,” reveals the president, who estimates that in the Canary Islands there are already at least 156 nutritionist professionals. , although “we are sure that there are many more of us,” says Monzón.
What are these specialties for?
These specialties forgotten in the health of the Canaries are precisely those that can help prevent many of the pathologies that the islanders suffer from. “A psychologist can prevent the excessive use of drugs – the Canary Islands is one of the communities with consumption of anxiolytics and antidepressants in Spain -, the chronification of the disease and help treat the pathology,” insists Cabrera, recalling that the socioeconomic situation of the Canary Islands It can lead to the population developing more mental health problems.
Physiotherapy can be crucial for patients, but also for the healthcare system. “We have enormous waiting lists, it can take a year and a half to see a rehabilitation doctor, and it is the only way to get to a physiotherapist,” says Bermúdez. These professionals prevent diseases from becoming chronic or complicated, saving the population money. “We are a cheap and efficient profession,” defends Bermúdez, who warns that, cWith the progressive aging of canaries, these pathologies will appear much more often.
And in an autonomous community where almost six out of ten people are obese or overweight, nutrition – like sport – is an indispensable part of care. “We can prevent chronic diseases and childhood obesity,” highlights Monzón, who insists: “if we tackle everything from the base, the results will be much better.”
The Ministry of Health, in any case, maintains its objective of continuing to strengthen these professional categories in the coming years. In fact, the +Primary Care strategy is to provide all health centers with at least physiotherapists and psychologists.