When something is in a fragile balance, a slight wind is enough to make it fall. That happens, more or less, with Primary Care in Spain. The system is so permanently stressed, say medical organizations and unions, that the arrival of summer – with its vacations and population movements – threatens to completely disrupt it. It cannot be said that it was not expected. Outpatient clinics suffer every summer season.
“We are in a moment of crisis, we will have serious health care problems,” anticipated this Wednesday the Minister of Health of Castilla y León, Alejandro Vázquez (PP), after an extraordinary meeting of the Interterritorial Health Council to address the summer plans of the communities. that Health called at the request of the territories governed by the Popular Party.
These communities expected from the meeting that the Ministry would accept “specific” measures such as reducing the training of MIRs for a few months to be able to hire them in the summer as ordinary personnel (not in training) or opening their hand to the incorporation of health workers who are in the process of being approved. your title and your specialty. “Deception” and “passivity” were two words used by PP councilors to evaluate the meeting; while the Ministry defended that it would not do anything that “breaches” or “breaches” the law, such as shortening the MIR period. “If 5% of the staff,” the proportion that corresponds to final-year residents, “derails you, there is a structural problem,” said Minister Mónica García.
These proposals – peppered with the crossing of responsibilities between institutions regarding who is competent for what and who is charged with what, one more summer, there will be personnel problems – occur in a particular context, which is superimposed on the usual difficulties of the season. . This year, the doctors who started in 2020 finish the MIR. So, the training began in September and not in May, as usual, due to the pandemic situation, so that, in a normal context, the R4 (MIR of last year) would have already finished their training period and, therefore, could be hired to cover the starters, for example.
As a solution, the Ministry is open to guaranteeing that the MIR can temporarily move destinations to alleviate the lack of personnel. Both to other teaching units (be they health centers or hospitals) and to places where there is no training as long as an assistant accompanies them. “This year’s situation shows that the system is so stressed that, without this infusion of substitutes that come from those who have finished the MIR, at the minimum, the communities collapse and ask the Ministry to finish earlier, to let them hire as specialists, that they put guards as deputies… We call for any irregularity that the residents see to inform us,” says Sheila Justo, vice president of the Association of Doctors and Higher Graduates of Madrid (Amyts).
There are 4,502 family doctors missing
The tension in the system can be measured with one piece of information: there is a deficit of 4,502 family doctors, according to a report commissioned by the Ministry of Health that was shared with the autonomous communities a week ago. The lack of doctors will continue to grow until 2029, when according to the model used in the report there will be 5,496 fewer than necessary. From that moment on, the forecasts will give a break and in 2035, if what is projected is met, there will be a surplus of family doctors.
This situation is explained by several factors: during the crisis years, the number of MIR positions that were offered were greatly reduced; The specialty is the one with the largest number of vacancies in each call (this year there were 246, plus those who resign after having accepted the position) and there is a large number of professionals who are over 50 years old. They are more than half (51.3%) and almost one in four is between 60 and 65 years old, according to the Report on the need for specialist doctors in Spain 2023-2035.
In consultations, health workers face the situation as “one more year in which we have to endure the struggle.” “It happens every year on vacation, but this one will surely be worse. We know that he is going to have to take us for exactly 15 days because if you try any harder you are doing a job to your teammates. We are mentally prepared, but it is another thing that is burning you,” says Hermenegildo Carreras, who works in a health center in Zamora and is a member of the Primary Care of the Collegiate Medical Organization (OMC).
The Ministry of Health assumes that the system is designed for the autumn and spring periods. And, therefore, every summer “beds and operating rooms are closed because we have a system that is not equipped with sufficient resources.” He conveyed this publicly and also to the industry advisors at the meeting with a veiled complaint. “They cannot ask us today to do the work that those who have the powers have not done for years,” said the minister.
What each community does
The consequences on the ground are the following: Galicia has offered doctors who have second homes on the beach to move from the center to take on the holiday population. The Catalan Institute of Health (ICS) has asked centers to reduce summer substitutions and will focus on tourist areas where activity will increase.
In Basque Country There will be a cut in hours in at least 126 health centers and unions have already reported problems with a lack of nurses in The Rioja. Cantabria It will have half as many substitutes as in previous summers with increasing tourist pressure in municipalities such as Noja, San Vicente de la Barquera or Laredo. Compared to around thirty substitute doctors that there were last year, this 2024 they barely make it to the fortnight, ten from outside Cantabria.
The Valencian Community, for its part, assures that summer puts 70 health centers at risk, which may have difficulties serving the population. Reinforcements have already been announced, like every summer, in 66 coastal points. Nuria Pascual works as a family doctor in two beach offices on the border between the provinces of Castellón and Valencia. She serves about 700 people in each of the locations (she is half a morning in one location and half a morning in another), but in the summer she only stays in one location because the other is reinforced as another physician starting July 1.
“In June you start to notice that the number of people coming is increasing and suddenly your population has tripled and you say: but what happened,” he says on the other end of the phone. “There are days when everything goes well and circulates, but other days I can’t be in three places at the same time. For the number of people we are, few things happen,” she says. Since she is alone in the office – only a nurse comes three days a week mid-morning – patients knock on her door without an appointment and “it is difficult to manage.”
This report has been prepared with information from the local editions of elDiario.es.