Francisco Goiri Madrid

Madrid

Updated Wednesday, March 27, 2024-10:15

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Next week, on April 5, the process of choosing specialties for future generations of Spanish doctors opens. On January 20,

José Manuel Sánchez took the MIR exam

and his grade was good, very good: he achieved 266th place, an excellent number, which allows him to choose a place in the specialty he wants and almost in the place that was assigned to him. craving

What specialty do you want?

Infectious Diseases, but they do not exist in Spain.

In our country the medical specialty is not recognized. Either José Manuel changes his specialty or emigrates to another place to do what he likes. He has a few days to think about it. Few.

Are there no infectious disease specialists in Spain? Yes, but

they are "infectologists without papers, people who have sought a life to train"

, as

Federico García García

, president of the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimc), graphically says. "We have to put an end to this atrocity," he adds, "and the only way is to approve regulated training." That is, a medical specialty via MIR, defends the president, "because the spectacular evolution that our field of action has experienced requires exhaustive training of several years." The specialty program proposed by the Seimc includes five years of training.

Infectious diseases is recognized as a clinical specialty in all EU countries (except Spain)

, in practically all Latin American countries and in the United States and Canada. In Spain, by law, it should also be: the decree that regulates specialized health training, and which the Government approved in 2022, establishes 5 criteria for a specialty to be recognized as such (having a field of action, defined competencies, dedicated specialists to it, provide specific training and have training resources), "and we comply with all of them," argues the president of the Seimc.

Sánchez has considered the possibility of going abroad, specifically to the United States or Sweden, but admits that the economic and language barriers are a handicap. What alternatives do you have in Spain if you persist in your idea of ​​being an infectious disease specialist?

The president of the Seimc responds: "The most common route is

to do the Internal Medicine residency, which has a specific rotation by infectious units of between three and six months

." 45% of the more than 4,500 members of the Seimc are, in fact, microbiologists, and 55% are infectious disease specialists, with degrees in specialties such as Internal Medicine (mostly), but also Family Medicine, Intensive Medicine...

The next step, according to García, is... crossing your fingers: "Rotating three or six months for infectious diseases is insufficient, but if a resident knows that infectious diseases are their thing, they can extend those rotations at the cost of sacrificing them in other services Now, everything depends on your tutor, the head of Internal Affairs and the infrastructure and equipment of the infectious unit of the hospital where you are trained."

This is corroborated by

Francisco Javier Membrillo

, vice president of the SEIMC: "My experience was that of a MIR of Internal Medicine who, from minute one, knew that he wanted to dedicate himself to infectious diseases, and who found himself with a rigid training program, with many rotations and that did not lead me to what I wanted to learn. Through many fights, disappointments and, it must be said, thanks to the support of my tutor, I managed to extend the initial four months of rotation. Even so, they were insufficient to train me as an infectious disease specialist, and I knew it.

The

early contact with Microbiology

at the Faculty of Murcia, where he studied, was, precisely, one of the reasons that led Sánchez to fall in love with infectious diseases. "In the 3rd year of my degree I studied Microbiology. I didn't even know that this kind of laboratory infectious disease existed, and I loved it." From there, the crushes followed: the clinical subject of Infectious Diseases in the 5th year of the degree; a three-week rotation in the Infectious Diseases unit of the Morales Meseguer Hospital, in 6th grade, and a proper name, Elisa García, head of Infectious Diseases at the La Arrixaca Hospital and her tutor in her final degree project (TFG). "For me it has been a reference," confesses Sánchez. The issue of her GFR confirms, by the way, that she was already clear about her preferences:

the effects of Covid-19 on kidney transplant patients.

The same dilemma that Sánchez has today was posed more than 20 years ago to

Luis Buzón

, head of Internal Medicine at the University Hospital of Burgos (HUBU). Two decades and things remain the same.

Buzón chose to do two specialties, Internal Medicine and Microbiology.

"Nine years of MIR, with what that implies: resident salary, resident working conditions, loss of opportunities, delay in professional projection... You

assume it because you pursue what you like, but it is insane.

You tell it outside of Spain, to colleagues from all the countries of the Western world, with whom we must and can compare ourselves, and they do not believe it. They do not conceive that we are still being trained like this."

As an internist (and head of Internal Medicine), Buzón knows very well what he is talking about when he says that the Internal Medicine residency "is very good for acquiring clinical knowledge and having a good foundation, but an internist is not an expert in infectious diseases; he is light years from being an infectious disease specialist, in fact, and my rotations were largely oriented towards these units.

The head of Internal Affairs at HUBU appeals to common sense: "It never occurs to anyone that a serious cardiological problem is managed by someone who is not a cardiologist or that a certain type of cancer is not treated by an oncologist who is an expert in that specific pathology; well, "If you suffer from a complex infectious process, the specialist who has to see you is called an infectious disease specialist. Either we are inventing the wheel or we are doing it very badly, and I lean toward the latter."

Membrillo agrees with Buzón that, if infectious disease is your thing, the Interna residency falls short. The HUBU internist did Internal Medicine and Microbiology, but Membrillo admits that he lacked that, "a basic rotation in Clinical Microbiology. An infectious specialist has to work with the data of the microbiological isolates and the results of the tests provided by our laboratory companions. You make up for those training deficiencies with experience, with hours and hours of study on your own and spending as much time as you can in the laboratory."

The professional, labor and organizational arguments to support the need for a specialty in Infectious Diseases are important, but there is another, "unappealable" one, to which "it is irresponsible to turn one's back," says the president of the Seimc: healthcare.

"

Infectious diseases are responsible for increasingly high rates of morbidity and mortality

, and the demand for care for problems directly related to them has not stopped growing in the last 40 years," argues the head of HUBU.

The list of these pathologies (or part of it, at least) speaks for itself: HIV and sexually transmitted diseases, tuberculosis and nosocomial infections; the annual epidemics of influenza, meningitis and hepatitis; hemorrhagic virus infections, such as Ebola and dengue; infections caused by multi-resistant bacteria and those that have caused major public health crises, such as SARS and, of course, Covid-19.