The discomfort of doctors | Opinion

In April 2007, the new health and biomedicine supplement of EL PAÍS opened with a topic titled The discomfort of doctors. Already then they complained of overcrowded consultations, low salaries, increasing pressure from managers and patients and few professional incentives. Shortly after the crisis arrived and from 2010 everything got worse with some cuts that left the health system in a critical situation. When it had not yet recovered, in 2020 the pandemic arrived. They received much praise and applause, but they came out of it much worse than they were, with a system afflicted with chronic deficiencies aggravated by successive crises and enormous fatigue. The accumulated malaise now surfaces in the form of strikes and protests that threaten to spread.

The diagnosis has been made for a long time, but the solutions have not arrived. The public powers affirm their commitment to public health, but the actions do not corroborate it. Today there are fewer primary care doctors than at the beginning of the pandemic, and in the next five years a third of the 42,000 family doctors and paediatricians will retire, and although an exceptional path has been planned so that they can extend their working lives from 65 years of age, that will not stop a hemorrhage that has many holes: those who retire, those who go abroad in search of more recognition and better salaries, and those who take refuge in private medicine. And those who are on leave due to depression or because they suffer such exhaustion that they stop exercising.

All these leaks increase the burden of care for the remaining doctors, fueling a vicious circle from which it will only be possible to get out with a crash plan that addresses the two main reasons for the discomfort: work overload and job insecurity. It is not acceptable that a third of doctors chain temporary contracts and that in some communities, such as the Canary Islands, the temporary rate reaches 60%. The discomfort is intense in primary care and emergency services, but it is also present in hospitals, where the pressure on care is also very strong. Low wages mean that many doctors have to do abusive shifts to improve their salary.

The 24-hour shifts are an example of an organizational solution designed more to meet the needs of the institution itself than those of doctors and patients. Such long guards imply a greater risk of error. Fear of making a mistake and fatigue add to the care burden they already bear. This is demonstrated by the fact that 87% of doctors perform shifts when 60% would prefer not to, and 70% of doctors continue to do so after the age of 55 despite being voluntary. It is not acceptable that those in whose hands something as important as the health care of the population is working under these conditions.

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