Are more doctors needed in Spain?

In its last meetings, much cited later by its members, the conference of deans of medicine and the state council of medical students they reasoned about the lack of doctors and against the opening of new medical schools. His arguments were the following. On the one hand, they recalled that, despite the increase in MIR positions in recent years, in the last calls there were more than two candidates graduated in medicine for each position (remember that practically all students who want to practice medicine have to go through the MIR system). The other argument, although accurate, was riskier: it said that with the increase in the number of vacancies or faculties (many of the recently created, private ones), the quality of training would be endangered. The central idea would be the following: more doctors should not graduate than the system can absorb.

Parallel to these positions that come from the university world, which are not new and are clear, the Ministry of Universities, the Ministry of Health and the Conference of Rectors have stood firm and anticipate increase medical graduate places by 15 percent and so it is contemplated in the budget.

The different levels differ significantly in the quantification of these impacts. In addition, the differences in the assessment of the situation and possible solutions are wide.

Although these approaches seem particular, because they affect medical schools in a special way, they concern not only the university but also Spanish health, when it is immersed in significant deterioration, as a consequence of the pandemic stress test, that affects the confidence of citizens, to which can now be added the question about the quality of the training that is provided.

We are on some fronts in which we verify daily the discontent that is generated by the lack of dialogue between the different administrations and the administered, particularly in primary care and also by the working conditions of health workers. As a background we can highlight the imbalance between specialties, the precarious situation of primary school and the dissuasion when choosing the specialty. Added to all this is another matter of great importance. As a consequence of the coronavirus, a true catalyst for digital transformation, the situation has worsened. So if we don’t subordinate digitization to a technological humanism, a lot will continue to be written and in very different ways about the deterioration of the level of health care, and the crisis will not stop appearing in the media, not only from the positions most interested in its deterioration.

It should be borne in mind that the needs for health and human or material resources will never be fully satisfied.

Because at this point, in parallel with the (post) pandemic, the signs of the crisis are quite visible (the pandemic has wreaked real havoc in the West). In this sense, among the issues that stand out and that date back a long time, are the lack of funding for the entire system, the precarious hiring of professionals, the working conditions of internal medical residents and a very marked tendency towards forgetting public health, the dismantling of primary care, and the strengthening of privatization that is perceived more strongly in some autonomous communities, with Madrid at the head.

The reaction so far of the coalition government, although it has launched legislative initiatives such as the equity law or the state public health agency, together with the agreement for the stabilization of interim personnel and additional budgets for primary care and public health, seems which is below the magnitude of the challenge.
In the same area, we must add the approval of the plan for primary care and the mental health strategy.

The need to take a radical turn and direct human resources towards other objectives that give guarantees of stability to young professionals remains strong

In summary, regarding the cyclical lack of medical and nursing professionals that has served as a justification for the continuous opening of new faculties, we have already commented that the majority of those that have been opened in recent years are private, in parallel with the already discussed dynamics of privatization of the health system. Seen what has been seen in these years, these are faculties that in many cases do not meet the minimum requirements of research laboratories, libraries and hospitals to carry out practical teaching with full guarantees.

In short, what we mean by all this is that the origin of the public health problem is a mixture of failure in the management of human resources in relation to great instability in the contracts of the youngest, a great deficit of financing and a great preponderance of hospital medicine over primary care that causes a great overload of hospital emergencies.

For this reason, the need to take a radical turn and orient human resources towards other objectives that give guarantees of stability to young professionals remains strong. It is necessary, more than ever, to design a map of specialists, a register of all health professionals to know where they are, and to know the current number and retirement forecasts for 2025.

Lastly, it should be borne in mind that health needs and human or material resources will never be fully satisfied. The causes for this are multiple, but the main one is that social unrest is reflected in the health system and the tendency will always be to medicalize it rather than solve it. A resolution that will always be partial.

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