Despite all investments announced by the Ministry of Health in recent months (and applauded by a large part of the health community), the main challenge of primary care, as well as his eldest threat, there is still a lack of doctors. It is a problem that not only shakes Catalonia, but to all of Spain and other European countries. According to the unions and medical societies, in Catalonia, there is a lack between 800 and 1,000 family doctors. In all Spain, about 5,000.
The health workers remember the importance of primary care being robust and this strengthened: it is not only the gateway to the system sanitary, but she solves up to 80% of health problems, in addition to acting as a detector of violence or loneliness. Investing in public health and, specifically, in primary care represents a saving, in the medium and long term, for the Administration. This April 12th is celebrated the National Primary Care Day.
Regarding the reason for the lack of personnel, which is an unquestionable fact, there are mixed opinions. Some voices attribute it mainly to the demographic crisis: there is a whole generation of medical boomers who are retiring (in Catalonia some will retire 900 in the next decade) and they don’t have replacement. Europe is increasingly aging, to which must be added that there has not been a good planning about.
But there are also voices that defend that the problem is not the lack of doctors, but the bad working conditions, that deter many from devoting themselves to family medicine.
“There are studies that say that it is not that there is a lack of doctors in the health system, but in the primary. And it is because They don’t want to work here something that happens in other countries and that has to do with the conditions where we work,” says Meritxell Sánchez-Amat, doctor of the CAP Besòs and president of the Fòrum Català d’Atenció Primària (Focap). Family medicine, he adds, is a “very complex specialty” in which the health worker works “with a very large uncertainty” and must be able to distinguish disease from non-disease with little technology”. “A remuneration level all this is not compensated either”, he laments.
In last year’s MIR call, about 200 places were left unfilled throughout Spain of family and community medicine, which reflects what not very attractive which is the specialty. The medical societies denounce that the situation is especially criticism taking into account that the MIR positions for family doctors throughout Spain They do not even reach 30% of the total places (when they should be the 40% of that total).
“We have a human and medical resources problem. There has been an increase in family nursing positions, but not in family doctors,” says Antoni Siso, president of the Catalan Society of Family and Community Medicine (Camfic). Of the more than 1,400 MIR positions in Catalonia, only 371 are for family and community medicine.
Last March, Salut announced that it would train 2,000 administrative staff to remove bureaucracy from doctors and nurses. The measure is part of system accessibility improvement plan promoted by the department and that supposes an investment of 110 million euros. According to Salut, the measures included in the plan are equivalent to the recruitment of 300 doctors and 100 nurses. However, this and the hiring of new professional profiles (nutritionists, psychologists, physiotherapists) demonstrate the real difficulties What is there to hire doctors and nurses.
other challenges
For Sánchez-Amat, another of the challenges facing primary care is the debureaucratization and stop doing “preventive practices that lead nowhere”. “For example, sometimes they are made analysis everyone in the same way, or supplementary tests They don’t add any value. All these are things that occupy lots of time and resources,” says. For her it is important that the health system “pivot” in the primary, as “vertebral axis” and “front door”. “We have to stop hypertrophy the urgencys from hospitals”, he points out. But, for that, you have to do primary school “more accessible”.
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For his part, Sisó sees an urgent need to renew the infrastructures of the CAPs. Last June the ‘ex-minister’ Argimon announced the investment of 450 million euros for it. “We haven’t seen them yet”, complains the president of the Camfic. Although there has been an “increase” in investment in the primary, It has been “very small” according to him. The Budgets approved last February agreed to increase the weight of the primary care in the total of Salut until reaching 24% through the provision of 3,240 million in this area. Thus, the long-awaited 25% will be touched: the percentage of total health care that, according to the WHO, should go to primary care.
According to the latest report from the Servei Català de la Salut (CatSalut), published last year, the primary made, in 2021, about 64 million views and 3.5 million referrals.