Nuria Monsó Madrid
Madrid
Updated Tuesday, January 23, 2024-00:09
More than
5,700 MIR
who finish their training this year
will not be available to cover the summer needs of the health system
.
This promotion began its residency four months later due to the pandemic.
The Collegiate Medical Organization (OMC) has put this issue on the table in a report, to which EL MUNDO has had access, to urge health services to think about a strategy for the summer taking this circumstance into account.
The pandemic had consequences for the health system not only in terms of care, but also in terms of training.
The MIR class that began its residency in 2020, although they took the entrance exam on time, did not join their places until September.
It is usually at the end of May.
As the contracts are for four or five years depending on the specialty,
many health services take into account the new generations of specialists
who finish just before June to
manage summer substitutions.
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But if the rest of the year the communities complain because they cannot find doctors, especially in primary care, this summer it will be more difficult, because
they will not be able to count on that batch of specialists either to cover staff vacations or to reinforce
the areas they They increase their population with tourism.
Why is it not legal for a MIR to practice as a specialist almost on the verge of graduating?
The
final year MIRs
, although in practice they are fundamentally autonomous,
are personnel in training
.
The report
Critical challenges in specialized medical training 2024. Report on the HR crisis and the end of the residency period in the summer of 2024
, carried out by the National Vocal Office for Young Doctors and Employment Promotion of the OMC, emphasizes that There are two circumstances: the
lack of specialists to care for the population and fewer assistants to supervise the residents
and who have to perform functions above their responsibility.
"A situation could arise where the highest standards of quality and safety patient care and resident training are not ensured," the document states.
"You cannot say that it was not known,
it has been known for four years
," explains to EL MUNDO, the member of Young Doctors and Employment Promotion of the WTO, Domingo Sánchez.
To date, he has not been aware that managers or administrations have a plan for the summer
.
"I have not heard the autonomous communities take a position, nor the Ministry of Health. It is the agents who have to agree, it cannot be left to free will, because it has consequences. There are not three professionals who are not going to go out, there are many."
"We are five months away, perhaps it is an opportunity to put on the agenda a problem that will affect healthcare this summer. We have just gone through a
tripledemic
that has shaken the system," Sánchez insists.
Using 'patches' to the detriment of training
This summer the situation is going to be more serious due to the number of residents involved, about 5,700, taking into account only the
four-year specialties and subtracting resignations
officially recognized by the Ministry of Health.
But this does not end this summer: next year is when some 1,600 MIR of surgical specialties and some more, such as Cardiology, Intensive Care, Internal Medicine, Medical Oncology and Urology, would finish.
Furthermore, in 2025 it will coincide that the bulk of the MIRs who entered in 2021 will also finish later, although they did so on July 20 (a month and a half later than usual), and in 2026, the MIRs of specialties will finish their residency. of five years that started with them.
This
late incorporation of the MIR class of 2020 was not the only
measure taken regarding residents during the pandemic.
For example, those who passed the 2019 MIR exam but did not get a place could be hired temporarily on an exceptional basis.
For the MIRs who were already being trained, their annual and final evaluation was temporarily postponed and the possibility of changing training itineraries exceptionally due to special needs related to Covid-19 was approved.
The report states that "in practice, this scenario did not entail the extension of the residence period of the MIRs that year, but it did involve a large number of changes in the training itineraries."
Sánchez is above all concerned about the case of the MIR of Family Medicine and Pediatrics, which are the two medical specialties present in health centers and precisely those in which there has been the greatest shortage in primary care for years.
He fears that, for example, they will be forced to travel to rural clinics that are not even accredited for MIR training.
"You cannot use the MIR first for legal reasons, because in the end they are still personnel in training, they have to have a certain degree of supervision."
What solutions can Health and the CCAA propose?
The report does not stop at the alert, but
anticipates two scenarios
that could occur in health services in this situation:
changes in the training itinerary of final year residents
that do not follow teaching logic, but rather to cover staff vacation periods structure of their services or even
forcing resident doctors to finish their training program several months early
to be available in the labor market and cover said vacation periods as specialists.
Both options are illegal, the document states, as they specifically contravene Royal Decrees 1146/2006 and 183/2008, which establishes the right of resident doctors to have their training program completed;
and
the healthcare needs of a service are not included as a reason for terminating the residence contract
.
The WTO document emphasizes that "the legislation regarding changes in the training itinerary is clear: it cannot be done for welfare purposes unless it is specifically decreed, as was done in the Covid-19 pandemic." "This is included in article 4 of Royal Decree 1146/2006 on the rights and duties of resident doctors. Therefore, they
have the right to have their training itinerary completed
, including the right to external rotations."
These rotations, on paper, are carried out precisely to comply with your MIR program, in the event that there are skills that could not have been acquired at your educational center.
On the other hand, the report points out that "the
legislation allows the end of the residency without having completed up to 25% of the annual working hours
(that is, about 3 months), in the event that there has been a suspension of the contract for the reasons included in article 45.1 of the Worker Statute", for example a temporary disability or high-risk pregnancy, etc.
The rule makes it clear that, if the interruption in MIR training were greater, the resident would necessarily have to extend his contract to compensate for this interruption or repeat the course.
"
The lack of health personnel due to structural and political planning problems is not included as one of the possibilities of termination
or termination of the contract," insists the WTO.
"The times established in the training programs of the different specialties must be respected, since they are
one of the guarantors of the quality of the specialized health training system of our country
and extraordinary measures must be planned as it is a predictable scenario," he insists. the institution.
"In addition to this, there is the risk of taking different measures given the variability between autonomous health systems. This possibility may lead to a scenario of greater inequity between communities."
For example, there could
be migratory flows that further increase territorial inequalities
in terms of access to the health system.
Furthermore, "making political decisions based on structural shortages of professionals can shake the credit and recognition of this system aimed at training under standards of excellence."
One more problem for the MIR
The report recalls that since 2019, different studies have been carried out in Murcia, the Valencian Community, Madrid and even at the state level promoted by the WTO itself, which has put figures on
non-compliance throughout the national territory with many of the labor rights of resident doctors
.
Among the problems that have been reported, they highlight that the MIR exceed the 48 hours per week of maximum working hours established by European labor regulations, the right to daily or weekly rest is not always respected.
The document indicates that another study in the province of Valencia pending publication shows that the rights to carry out external rotations, to attend training conferences and to respect the training itinerary in multiple teaching units are also violated.
In July 2023, the WTO published a document with different measures to alleviate the so-called "medical deserts" based on the recommendations of the
World Health Organization (WHO) and the vision of young doctors themselves.
However, "
the general tendency is to maintain a passive attitude towards human resource planning
, or to carry out only partial actions, in some cases with possible long-term negative consequences"