When he graduated, his brother Manuel Jimenez He gave him a stethoscope. He lasted more than ten years. After retiring the device he had the option of asking for one from the health center but he preferred to buy one out of his own pocket. “Let’s say that the one at the health center does not meet expectations.”
The first thing you associate with a doctor is the gown and the ‘phonendo’. Jiménez, a specialist in family medicine who alternates between the emergency service of the Don Benito-Villanueva de la Serena Hospital and a health center in Don Benito (province of Badajoz), uses it “In 80% of patients who come for consultation, it is essential“.
But what his center offers him, he believes, “does not help you considerably in the performance of your work.” You need a higher quality one to be able to hear well inside your patients, “which It means spending about 300 euros“.
Jiménez’s case is no exception. The vast majority of doctors have to purchase the equipment that makes their work easier with their own money, either because their center does not provide it, or because the quality leaves something to be desired.
“During the fourth year of residency I bought a portable ultrasound machine because I saw that it was an increasingly essential tool,” recalls the internist. Miguel Galan de Juana.
[El 68,7% de los estudiantes de Medicina proceden de familias con ocupaciones altas: el polémico informe]
“Thanks to this I have had specific cases that They have allowed me to speed up the diagnosis and save lives“.
Of course, the device, which is attached to the mobile phone and allows an ultrasound to be performed almost anywhere and at any time, cost 2,000 euros, to which we must add “a subscription to software annual from 60 to 300 euros, depending on the benefits”.
Galán lists cases that he knows of from former residency colleagues and acquaintances from other specialties. A lens to look at the fundus of the eye costs about 400 euros. The dermatoscope that evaluates skin lesions can cost between 1,000 and 1,700 euros“to which we must add maintenance (repairing it can cost 500 euros) but also a camera and a hard drive to save the images.”
An inclinometer, which is used in rehabilitation to measure the curvature of the spine, costs about 200 euros. And glasses with a magnifying glass for performing surgeries can reach 3,100 euros.
All this material, as a general rule, has to be acquired by the doctor himself. Some of the prices mentioned include a discount given by manufacturers and distributors when purchased at medical conferences.
[Los médicos con las mejores notas MIR ya no quieren ser pediatras: así se ‘desinfla’ la especialidad]
A resident explains to the Federation of Health and Social and Health Sectors of CCOO Andalusia that in some hospital floors there are ‘phonendos’ that staff can use “but these are usually old, in poor condition and of very poor quality, not being suitable for continued use nor that it can be used beyond a specific moment”.
There is also other material, such as the reflex hammer used by neurologists, that is not provided by the center. And “in the emergency services There are usually tools for exploring the nasal and auditory cavities, but they are often in poor condition or unusable. and some colleagues choose to purchase them in portable format.” The list of devices seems endless.
Manuel Jiménez also remembers that the briefcase he carries when he sees patients at home was 250 euros, and a reference manual for emergencies was close to 200 euros.
“In the Extremadura Health Service you can consult online versions of some books, but accessing it from another computer other than the work computer is quite laborious and I prefer the book to review and study.”
All of this disbursement is usually made by doctors in the first years of residency, when the salary of the average MIR is around 1,100 euros net.
Buy the ‘fund’ in installments
Jiménez, who is from the Sevillian municipality of La Algaba, had to subtract from the figure the rental of housing in Don Benito, where he took the MIR, and the car to be able to get around.
“In the end you have to save a few months if you want to buy a ‘fonendo’, or pay it in installments,” he points out.
Royal Decree 1146/2006, which regulates the training of MIRs, establishes the right of residents to “have the means and resources necessary for the adequate development of their training.”
Miguel Galán recalls that the collective agreement of the personnel of health institutions of the Madrid Health Service establishes, in its article 59, that “The Administration will guarantee the provision and maintenance of the equipment and materials necessary for the proper performance of the functions of health personnel.“.
However, it seems to be assumed that portable or personal equipment is acquired by the doctor on his or her own.
[El hospital al que ha dicho ‘no’ Noelia García, la número 1 del MIR: las razones de la dermatóloga]
“This culture of being the one who pays for it, that this is something socially accepted and that we do not demand it, can act against the equity of access to residency, but also to medical schools,” he laments.
A recent report from the Ministry of Science concluded that career choice is determined by the socioeconomic status of the family.
Thus, 68.7% of Medicine students had parents—one or both—with occupations that imply a high socioeconomic level: business management, scientific and intellectual technical and professional positions, and support technicians and professionals.
In fact, Medicine is the career with the highest percentage in which both parents have high occupations, both in public and private universities: 31.9% and 46.5%, respectively.
“It is an additional barrier to equity, an expectation that already begins the moment you begin studying the degree: It is assumed that you are going to spend a lot of money on text materials, dissection kits, etc.. There are also no scholarships available for these materials or clear information on how to obtain them.”
The commitment of professionals
In the end the situation depends on the center. The young doctor points out that, of the three hospitals in which he has worked, the large ones are the ones that offer more personal equipment, “perhaps because they have more money thanks to collaborations and prestige… But this represents a comparative insult.”
Jesus Jordanresponsible for Employment of the Federation of Health and Social and Health Sectors of CCOO, tells EL ESPAÑOL that “the material is not always provided and, what they do provide, in many cases and at a general level is of poor quality, in the desire to reduce spending on the health of patients.
From the Andalusian branch of the union they point out that there are differences. “In the southern district of Granada, this year they have given them a ‘phonendo’, but it seems that it is the first year that they do it. In Córdoba and Guadalquivir, nothing at all. In the consultations there may be a blood pressure monitor, otoscope and ophthalmoscope fixed on the wall , But nothing more”.
[Por qué los exámenes tipo test perjudican a las mujeres en las pruebas MIR: la brecha de género]
Jordán points out that administrations invest in the training of health workers but do not provide them with the best means to carry out their work “It is one more reason why they withhold resources for optimal patient care.“.
However, the commitment of Spanish professionals stands out, “who spend out of their own pockets to buy quality material that equips them with the best tools for patient care.”
“It is the perversion of the administrations and the deterioration of public health services. And, despite everything, it is the professionals themselves who guarantee good care, providing their own resources.”