The lack of medical coverage during the summer is a recurring problem in Spain. However, this year in particular, the situation is expected to be even more serious. The Covid-19 pandemic produced a Delay in the incorporation of resident physicians (MIR). Thus, instead of starting in May, they did so in September. This has generated an additional deficit in the availability of health professionals at a critical time. This delay, combined with the need to cover the vacations of regular medical staffhas exacerbated the shortage of doctors in many areas, especially in rural areas and primary care centers.
Faced with this situation, the Popular Party has on several occasions demanded that the Executive study that fourth-year MIRs can see patients in Primary Care centres during this summer even though they end in September. The proposal was rejected by the Minister of Health, Mónica García, since, according to her, the Ministry’s duty was to guarantee the training of these professionals.
This non-binding motion was also debated on Tuesday in the Congress of Deputies and caused some groups in Congress, mainly the left-wing bloc, to reproach the Popular Party for having used health as a political weapon. However, last Thursday, June 27, the initiative was approved with the majority of votes in the Upper House.
In this way, an attempt has been made to solve the problem this summer. However, this is not a one-off issue. For years, Our health system is facing a huge problem which inevitably impacts the efficiency and quality of care. The situation affects Primary Care (PC) much more noticeably. Doctors, pediatricians and other health professionals working in health centers bear the brunt of the crisis. excessive workloads due to high patient volume and shortage of colleagues; lack of time to dedicate to the patient due, in part, to facing a large amount of administrative tasks; salaries and other unattractive working conditions; among others.
“We are spectators of the continuous lack of professionals in certain sectors of family and community medicine,” laments Víctor Pedrera, general secretary of the State Confederation of Medical Unions (CESM).
Doctor Vicente Matas, from the Vicente Matas SIMEG Studies Centre Foundation, shares the same opinion. “This year we have been surprised by the fact that Almost 250 Family Medicine positions have been left unfilled. And this is because the PA is in very bad condition, the workloads are unbearable. And it all happens because there have been a lot of cuts, so now we have an insufficient budget.
For his part, Tomás Cobo, president of the General Council of Official Medical Associations, emphasizes that the problem of the lack of doctors in AP “has been known for 30 years.” «It is a chronic problem that, as time has passed, has become more complicated. Furthermore, this situation is very common, unfortunately, throughout Europe,” he denounces. The president of the highest representative body of doctors proposes take effective and harmonized measures between the Government and the Autonomous Communities. “It is of no use if a counselor has the idea of paying more in his region to take doctors from another,” he says.
Powers of the Ministry of Health
Although in Spain, health responsibilities are decentralized and managed mainly by the autonomous communities, the central government also plays an important role in coordinating and regulating the system. In fact, according to experts, The Ministry of Health has the power to address these problems through a series of strategic and well-coordinated measures. Since November 2023, this responsibility falls on Monica GarciaThe Minister of Health has called 9 meetings of the Interterritorial Council of the National Health System (CISNS).
«The work of this minister, during this time and within the framework of her powers, has been aimed at trying to strengthen the co-governance that must exist with the autonomous communities. And she has addressed two worrying issues: primary care and summer coverage to try to take measures that are linear. However, implementation is lacking. In other words, there is no crisis of ideas, there is tons of literature, but the issues must be developed,» says Tomás Cobo.
According to Vicente Matas, despite the fact that a CISNS monograph was held on the problem of the lack of doctors in the summer, The Ministry has identified the problem very late: «We knew about it since the summer of 2020 and not only has nothing been done in all this time, but obstacles have also been put in the way of those who proposed solutions,» he points out. And he recalls that health is a fundamental issue for the population. «We must stop focusing on political colors and using Health to attack the opposite, and row all together at the interterritorial level to solve these issues. Matas also demands real solutions: “It’s time to move from words to actions. Nothing has been put on the table yet.”
The lack of implementation of solutions by the Ministry of Health is also criticized by CESM. “The only thing we have had so far have been declarations of intent with little support. And What we are asking for are concrete solutions, with details, numbers, and deadlines.“, says Victor Pedrera.
The CESM spokesperson points out that the Ministry of Health has the authority to adopt many measures aimed at improving the health situation. «The first of these is to plan postgraduate training. In Spain there is no shortage of medical schools, what is lacking are doctors with specialization willing to work in the public system. Measures must also be established to retain professionals and this would be achieved by adapting the framework statute that contemplates labor improvements; however, the Ministry has not wanted to draw up a specific statute, which for me is a mistake because the medical profession has specifications of such importance as to justify making one for us», he points out.
Measures to solve the problem
According to experts, some solutions involve increase the budget allocation, optimize the administrative tasks or guarantee a equitable distribution of resources.
«Primary Care needs more budget, without cutting back on other sectors, but a significant increase is necessary to finance more staff, both for doctors and for technical-administrative and support staff in the consultation to ensure that doctors have more time to deal with patients’ medical problems. It is also necessary to improve remuneration conditions, working conditions, offer long-term contracts to new specialists, incentives in isolated centres that are difficult to fill and OPES announced in June, resolved in months and not years, so that the majority of new specialists stay in Spain and in Primary Care», says Vicente Matas. And he specifies: «The solutions involve increasing the budget, up to 25% of the public health budget, although obviously, this will have to be done over several years, with an initial objective of 20%».
From 2009 to 2022, Primary Care has reduced its participation in public health investment by one point, going from 15.3% to 14.3%. In these years, the increase in investment has been 2,392 million (22.2%), while the increase in the SNS has been 21,493 million (30.5%), the increase in Hospital Services has been 16,594 million (42.3%). This negative evolution comes from afar, since from 1980 to 2022, Primary Care has gone from 20.9% to a scant 14.3%. Meanwhile, hospital services have advanced 5.8 points, from 54.9% to 60.7%.
Another of the proposed solutions involves a significant increase for finance more staff, both doctors and technical-administrative staff and support in the consultation. “We need to ensure that doctors have more time to deal with patients’ medical problems,” says Vicente Matas. It is also necessary to improve remuneration and working conditions, offer long-term contracts to new specialists, provide incentives in isolated centres that are difficult to fill, and call for OPES in June, resolved in months and not years, so that the majority of new specialists stay in Spain and in Primary Care.
Historical cuts
The public health investment in Spain that existed in 2009, before the crisis and the corresponding cuts, was a total of 70,579 million euros in the SNS, of which a scant 15.3% was dedicated to Primary Care ( 10,775 million) and despite this insufficient and unfair budget, the cuts between 2009 and 2013 were much more important in Primary (1,651 million, 15.3%) than in the SNS (12.6%) and much more than in Hospital Services (1,850 million, 4.7%). In 2013, only 14.8% of public health investment was invested, compared to 15.3% in 2009.
When the economic recovery arrives, Primary Care, which suffered greater cuts than the average of the SNS and than the Hospital Services, increases its investment between 2013 and 2022, less than the SNS, 44.3% Primary Care compared to 49.2% of the SNS and less than the Hospital Services, which increased by 49.3%. Primary Care goes from 14.8% in 2013 of public health investment to a meager 14.3% in 2022.