Is there a need for more doctors in Spain?

In their last meetings, much quoted later by its members, the Conference of Deans of Medicine and the State Council of Medical Students they argued with the lack of doctors and against the opening of new medical schools. His arguments were as follows. 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 who graduated from medicine for each position (remember that practically all students who want to practice medicine must passed through the MIR system). The other argument, although accurate, was riskier: it said that as the number of vacancies or faculties (many newly created, private ones) increased, the quality of teaching would be threatened. The main idea would be this: not to leave more doctors than the system can absorb.

Parallel to these positions that come from the university world, which are not new and are clear, the The Ministry of Universities, the Ministry of Health and the Conference of Rectors they stand firm and wait increasing medical graduate places by 15 percent and so it is budgeted.

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

Although these approaches seem specific, as they affect medical schools in a special way, they affect not only the university, but also the Spanish health care, when it is immersed in a significant deterioration as a result of the pandemic stress test, which affects the confidence of the citizens, in which already the question of the quality of the training being provided can also be added.

We are on some fronts in which we daily check the dissatisfaction that is generated by the lack of dialogue between the various administrations and the administered, especially in primary care, as well as the working conditions of health workers. As a background, we can highlight the imbalance between majors, the precarious situation of primary school and the dissuasion in choosing a major. To all this is added another question of great importance. In the wake of the coronavirus, a true catalyst for digital transformation, the situation has worsened. So, if we do not submit to the digitalization of technological humanism, there will continue to be a lot of writing in various ways about the deterioration of the level of health care, and the crisis will not stop appearing in the media, not only from positions most interested in its deterioration.

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

Because at this moment, alongside the (post)pandemic, the signs of the crisis are quite visible (the pandemic has wreaked real havoc on the West). In this sense, among the problems that stand out and date back a long time are the lack of funding for the whole system, the insecure employment of professionals, the working conditions of internal doctors and a very marked tendency to forget public health, the elimination of primary care and the strengthening of privatization, which is perceived more strongly in some autonomous communities, with Madrid in the lead.

The coalition government’s response so far, despite launching legislative initiatives such as the Justice Act or the state public health agency, along with the agreement to stabilize temporary staff and additional budgets for primary care and public health, seems to be below the scale of the challenge.
In the same area we need to add the approval of the primary care plan and the mental health strategy.

The need for a radical turn and directing human resources to other goals that provide guarantees of stability for young professionals remains strong

In summary, regarding the cyclical lack of medicine and nursing, which serves as a justification for the continuous opening of new faculties, we have already commented that the majority of those opened in recent years are private, in parallel with the already discussed dynamics of the privatization of health system. In view of 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 conduct practical training with full guarantees.

In short, what we mean by all this is that the origin of the public health problem is a combination of human resource management failure in relation to high volatility in junior contracts, high funding shortfalls and high sick leave medicine over primary care, causing major overcrowding of hospital emergencies.

For this reason, the need for a radical turn and directing human resources to other goals that provide guarantees of stability for young specialists remains strong. More than ever, there is a need for a specialist map, a register of all healthcare professionals to know where they are and to know the current numbers and retirement projections for 2025.

Finally, it must be borne in mind that health and human or material resource needs will never be fully met. The reasons for this are many, 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 to resolve it. A solution that will always be partial.