There are not enough doctors or nurses. The second wave of covid-19 has once again highlighted the lack of toilets in the National Health System (SNS). A structural problem that is not completely solved in a few months, but for which enough alternatives have not been sought either: neither the necessary hiring nor the reorganization of consultations in which professionals – especially those in primary care – live buried under a mountain of patients and bureaucracy.
The diagnosis is almost unanimous. It is shared by unions, medical societies and even political leaders. The president of the Community of Madrid, Isabel Díaz Ayuso, acknowledged this Monday: “Spain has a problem of lack of doctors and nurses.” Compared to the OECD, the country is above the average in doctors of all specialties. But if measured with the European Union, it falls far behind in primary school physicians (76.5 compared to an average of 123.4 per 100,000 inhabitants, according to the latest Eurostat data) and in nurses (520 per 100,000 inhabitants compared to 840 in Europe). And these were the ones destined to serve as a containment dam so that the second wave of the coronavirus was not as violent as the first. But they have seen completely overflowing from the first bars, when they began the summer depleted by the holidays that corresponded to them.
Faced with questions from journalists, Fernando Simón has recognized this Monday in some services there is “a chronic complaint of lack of resources or overload”, although he could not specify whether this is due to a lack of professionals or to organizational and resource management deficiencies. “I think that right now we have enough equipment to work, the doctors in Spain are the ones that exist, the first wave passed with difficulties, but it passed thanks to the inhuman effort of the professionals. I think it will not be so hard, but it is clear that we would like to have a greater number of doctors, because in Spain, as in all countries, it is limited ”, he added.
This rickets of toilets is reached by several shortcomings. One is the chronic precariousness in which many professionals in the system live. A 2016 study by the Collegiate Medical Organization revealed that half of the SNS doctors do not have their own place. Of them, 40% signed contracts of less than six months. Hiring these professionals who are in the orbit of the system would solve part of the problem, but not all. Because they are not enough. Ayuso also pointed out this Monday: the system does not produce enough toilets to take over those who are retiring, and in the coming years this will increase, so he asked the president, Pedro Sánchez, incentives to attract doctors and nurses. Or to stop those who leave before such precariousness. The problem particularly affects Madrid: according to calculations by the CSIF union, 70% of the people who finished the MIR this year in the Community have chosen a destination outside of this autonomy due to conditions that they call “regrettable”.
Lorenzo Armenteros, from the Spanish Society of General and Family Physicians, explains that for the proper functioning of the system, between 4,000 and 6,000 family physicians would be missing, that is, around 14% of those that already exist. And this without a pandemic involved. It is the same, on another scale, that happens in Madrid. Julián Ezquerra, from the Madrid Association of Physicians and Graduates, estimates that the community would need 600 family doctors and 150 pediatricians, that is, 15% of the total; just to cover regular casualties and to provide routine service.
With the covid, all this multiplies. “It has overloaded the system more, it has generated a situation of increasing bureaucratic overload for the elementary school: procedures, prescriptions, medical reports, receipts for school, for sick leave for parents, in addition to the monitoring of covid cases” says Serafín Romero, president of the General Council of Official Medical Associations (CGCOM), who calls for an “IFEMA plan” in primary school. “Just as coronavirus patients were referred to a special infrastructure, we ask that certain burdens be removed from doctors, both bureaucratic and carrying out the tests and communicating the results so that they can stay with their real job: caring for patients and to properly monitor them, both for covid and other diseases, ”Romero emphasizes.
The CGCOM also asks to begin to articulate a contingency plan, similar to the one made in spring, so that both retired doctors and non-specialized graduates can join the system to do complementary tasks that release doctors who are “overworked”. This plan, in the first wave, was intended to attract more than 50,000 professionals, but eventually only a few thousand were integrated into the system.
Nurses (the group calls itself feminine) are also looking for solutions. “There are many hospitals that are desperate because they need to hire nurses to be able to respond to the covid-19 pandemic, but they are not able to do so because there are no unemployed nurses and the job boards are completely exhausted,” says Florentino Pérez Raya, president of the General College of Nursing. Together with the Spanish Private Health Alliance, it has requested the Ministry of Health and the regional councilors to adopt a regime of absolute compatibility for the free exercise of health care between the private, concerted and public sphere of these professionals for the duration of the pandemic, since, until now, with some exceptions, a nurse who already works full-time cannot practice anywhere else. “If this measure were adopted, it would be possible to alleviate, at least in part, this shortage of nurses, also avoiding competition in the recruitment of professionals,” adds Pérez Raya.
Scarcity also in ICUs
The Minister of Health of the Community of Madrid, Enrique Ruiz Escudero, announced this Monday in an interview on Antena 3 that, once the IFEMA hospital is reopened to reinforce the Madrid health system, no new hires will be made, but that volunteers hired in other hospitals will be sought to transfer them. “This is reckless, it is undressing a saint to dress another,” says Julián Ezquerra, who considers that it would be a question of dismantling services in which professionals are necessary, something that was already done in spring, when some health centers were closed to strengthen IFEMA.
The shortage of qualified professionals is leading to a search for alternatives. María Bodí, coordinator of the Planning, Organization and Management Working Group of the Spanish Society of Intensive Medicine, explains that ICUs are already feeling the pressure, since in addition to all covid patients, in most cases they continue providing regular care (although in some hospitals non-urgent operations have already been deprogrammed so as not to saturate them). “As much as the beds and respirators are increased, doctors and nurses are needed to attend to them,” he stresses. In a particularly complex specialty, you are demanding more places, but you are also looking for a faster solution. In October his society, together with the European Union, will launch three-month training courses to train health workers so that they can lend a hand in the ICUs in the face of what is looming as a difficult winter – if not Fall is already — in these units. During the first wave, other colleagues (anesthetists, pulmonologists…) were already used to support the critics. “At that time, practically all the hospital personnel were overturned with the covid, the ideal is that this does not happen again and we can continue to treat other pathologies,” says Bodí.
This extra work is also being reflected in the mood of the professionals. Throughout the pandemic, various surveys have reflected the extent to which many toilets are overwhelmed by the workload. The latest has been published this Monday by the Spanish Society of Internal Medicine, whose doctors have treated, according to their data, 80% of non-critical hospitalized covid patients. 86.8% of those consulted say they have felt concerned about the possibility of infecting relatives in the pandemic and 29.8% have had to separate from their usual partners. Almost 40.1% of the participating internists present signs of burnout syndrome (They are burned by their work) and 58.3% show high emotional fatigue.
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