Close to one in four Spaniards suffers from a rheumatic disease; rheumatologists complain about the long waiting lists and the lack of generational relief due to the retirement of many colleagues
Nearly one in four adults in Spain suffers from a rheumatic disease. Rheumatoid arthritis, gout, ankylosing spondylitis, lupus, osteoporosis…are some of the more than 200 ailments that affect almost eleven million Spaniards. In interview with the THE SPANISH NEWSPAPERfrom the Prensa Ibérica group, Dr. Marcos Paulino, president-elect of the Spanish Society of Rheumatology (SER) and head of the Department of General University Hospital of Ciudad Realaddresses the problems faced by the specialty such as waiting lists that reach up to ten months in some communities –“it’s outrageous, precise”– or something that worries them enormously: the generational change. The collapse of Primary Care, the flood of referrals or the lack of specialists has causedsays the doctor, the “perfect storm” in Rheumatology.The SER has been warning about it for some time. Data from this scientific society show that need to increase the total number of specialists by just over 450 over the next 15 years, that is to say around 40%, to meet the growing needs associated with the increase in the life expectancy of the population. This, explains Dr. Paulino, would lead to a rate of rheumatologists of 3 per 100,000 inhabitantswhich would be ideal.
But the truth is that the situation is far from that perfect percentage in several communities. The specialist himself has warned of how the waiting lists continue to increase significantly and generate inefficiencies and inequities in the clinical practice of rheumatology services. Waiting lists that, in surgery, with data known this week from the Ministry of Health, have broken all records and that do not improve if it is about external consultations.
cycle change
Dr. Marcos Paulino it points to the lack of communication with Primary Care and with other hospital services with which there is a direct relationship in the approach to musculoskeletal diseases; as well as the scarcity of agreed protocols or, if any, for not being able to fulfill them “because of the bad conditions” of work. “There has been a remarkable change in terms of to the lists of pre-pandemic years, with those of late. We have gone from an average wait of a month and a half or two months to places where it is 6, 8 or 10 months and it is outrageous“he points.
Delays are influenced by the collapse that is taking place in Primary Care and the “flurry of referrals” of patients
The rheumatologist admits that the collapse that is being experienced in Primary Care influences and speaks of a “flurry of referrals” of patients. He explains: “to having less capacity and resources, more is derived because there is no time to see that patient correctly”. In addition, of course, “the lack of rheumatologists that is taking place has an influence. It is worrying because it is a specialty that, potentially, has many patients. In Spain there are eleven million rheumatic patients. Not everyone makes it to the rheumatologist. Many are handled in Primary School and others don’t even know they are,” says the specialist.
doctors retirement
What your scientific society has seen is the deficit of specialists due to “the retirement of the generation of baby boom and because the number of rheumatology places has not increased“. Taking into account the aging of the population, closely related to rheumatic diseases, they calculate that “we would need around 450 more, which is surprising“says the doctor.
Especially bleeding is the situation in rural areas. “A ’emptied rheumatology’ is taking place in areas that they run out of specialists. Doctors don’t find it attractive. There would have to be a series of incentives on the part of the administrations so that those places that are now deserted, take cover. To offer something so that the younger people go there to work“, says the president-elect of the Spanish Society of Rheumatology (SER).
The patient, the injured
The problem, he highlights, is that this affects the patient. “Because they do not have any access to a rheumatologist and are evaluated by other specialists and it is not the same.” He describes how, in his specialty, very frequent diseases are addressed, which are the second cause of consultation to the GP, after respiratory infections. They are also the first cause of disability retirement.
Around 15% of Primary Care consultations -or one in ten visits to the Emergency Department- are for these diseases
With data from the SER, around 15% of inquiries Primary Care -or one in ten visits to the Emergency Department- are due to these diseases that usually appear between the ages of 25 and 45 and which, another powerful percentage, have a female face: 80% of patients are women. An example: for every man with rheumatoid arthritis, three women suffer from it. In most cases, with ages between 40 and 60 (some 200,000 people affected in Spain) and of long evolution, with high levels of pain and fatigue.
Inequity in access
Dr. Marcos Paulino talks about inequity in access. It refers to the results of an investigation carried out by the Investigation Unit of the Spanish Society of Rheumatology, 2021. They are the most current data available to them and he does not believe that they have changed much. According to this study, the rate of rheumatologists in Spain remains above the 2 per 100,000 inhabitants (2.17), although significant variations were detected between the autonomous communities. Specifically, the lowest proportions of specialists are registered in the Valencian Community (1.6), followed by Basque Country, Andalusia and the Balearic Islands (1.7), and the highest in Cantabria (3.6) and La Rioja (3.2).
Rheumatology is currently a specialty with a greater presence of women (59.7%) than men
In addition, the document details that, among the specialists with younger ages, women predominate: with a majority of ages below 54 years. In this sense, rheumatology is currently, unlike previous decades, a specialty with a greater presence of women (59.7%) than men. However, above the age of 50, the weight of men is still greater than that of women, the report indicates.
MIR squares
Rheumatologists ask for an increase in MIR positions in their specialty to improve the approach to these diseases. “The most important thing would be to increase these places and for that it is necessary that they be accredited more hospitals capable of training rheumatologists. But also to do so we need to update the criteria of the Ministry and the communities to allocate these places because they are from 15 years ago. For example, to be given a MIR resident in 2008, -last update date of these criteria- a certain number of patients is neededOtherwise, they don’t give you,” explains the specialist.
It abounds that this is a stumbling block because, currently, with the new treatments, they have achieved that “many patients do not enter and can be managed from home. So, there are hospitals that do not reach -that number of patients- because it is obsolete”. Finally, the doctor advocates that, once there is a sufficient number of places, “trying to make care as homogeneous as possible and in those positions that are not covered, promote incentives“.