"Teresa has been very important in my life, she has taught me how to treat a baby. The role of a pediatrician is crucial. " Sara Esteban is smiling when she talks about the doctor who has helped her deal with the revolution that brought the birth of her children, who are now 5 and 7 years old. This 40-year-old from Madrid has lived in Aranda de Duero for two decades, a municipality of 30,000 inhabitants 80 kilometers from Burgos, which is on the warpath to fight against lack of pediatricians in primary care caused by poor working conditions: overload of patients, eternal days and extra work when colleagues are missing.
The Spanish Association of Pediatrics in Primary Care warns that in Spain 1,600 pediatric spaces are not occupied by specialists, 25% of the 6,402 existing. This situation leaves, according to their estimates, almost 1,600,000 children without the specialized care recommended by the World Health Organization (WHO). In the last decade the population under 14 years has increased in greater proportion than the number of pediatricians. In 2008 there were 5,962,884 children and 6,215 pediatricians. Ten years later there are 276,000 minors and 291 more specialists: seven more children per pediatrician.
Aranda de Duero is presented as one of the most bleeding cases. The own autonomic Government admits that "there are no doctors" to occupy the available places. Three pediatricians left in October and there are still two vacancies. No doctor applied for them. The pediatricians who remain in Aranda handle between 1,000 and 1,100 health cards each, when the ratio that medical organizations consider optimal to guarantee quality is 900.
Those who have it worse are the children who live in the more than 60 villages of the Douro region. They only have one pediatrician, assigned to the rural ambulatory of Aranda, which deals with 1,200 cards from three health zones. Therefore, in addition to serving them in the municipality, they go to the health center of Roa de Duero twice a week and one to Huerta de Rey. "We have to program our children to get sick the next two days. And cross your fingers so that you do not have the full number of patients, "says Sara García, Roa's neighbor. The coordinator of the rural center, Luis Arranz, wants a new doctor and recognizes that this doctor, who is an area pediatrician (it is called that because it is not fixed in a health center), also assumes part of the work of colleagues from Arandina. emigrated.
According to the estimates of the Spanish Association of Pediatrics in Primary Care, 41% of the 6,506 pediatricians who visit the Spanish health centers and clinics are over 55 years old. In addition, almost 23% of this workforce exceeds 60. And, in Castilla y León, almost 20% are in retirement age.
Pediatrician Pablo Oyáguez urges the regional government to encourage contracts in rural areas; to improve working conditions and to devote more budget to primary care. The overload of these professionals is greater in rural areas because they travel tens of kilometers to attend to children. In addition, as reported by the sector, the Administration should hire three pediatricians in the primary care teams of the centers of Roa de Duero, Huerto and Aranda Rural (Burgos). Only one pediatrician is allocated for every 600 children, but each one of these zones does not add up to 600. All together, however, exceed 1,200 minors, but for legal reasons they are left with only one pediatrician. The associations in defense of the health ask that the Government change the scale of assignment of pediatricians.
The president of the Spanish Association of Pediatrics, María José Mellado, sees the situation with concern. "The WHO already warns that minors have to be seen by pediatricians until 18; the professional must be a person close to the child from a very young age to follow their development throughout adolescence ". This specialist, head of the pediatric service of the Hospital of La Paz, argues that there is evidence that shows that the health of children improves if they are attended by a specialist. "For example, vaccination coverage is above 92%. This is very important; in Spain there has not been the outbreak of measles in France, "he says. And he adds that rural areas are the hardest hit, where he estimates that between 50% and 60% of children are not treated by a pediatrician. Something corroborated by Dr. Concha Sánchez Pina, president of the Spanish Association of Pediatrics in Primary Care: "The specialists in children's medicine have received specific training for children for four years, while those of family rotate in a much lower percentage in the care to minors. "
In Aranda de Duero the deficit of pediatricians leads to children who are treated by the specialist to do so for less time than the counselee. "The worst thing is that my 4-year-old son will soon be seen by the family doctor," Roa's mother says indignantly, because rural children leave the pediatric office before the age of 14.
The population of the area has taken to the streets several times in recent months to demand more investment and specialists. Sara Esteban, the mother of Aranda, began four months ago to collect signatures with the help of two friends when she had to say goodbye to her pediatrician in October. Calls for a quality public health in the region before "the flight of doctors." At the close of this report I had already collected 6,000 signatures. But Esteban wants more, because in the day to day "there are cancellations of appointments, delays and saturation of urgencies". And that is why in his free time he will go through town by town picking up more.
According to the Spanish Association of Pediatrics in Primary Care, only Madrid with 17 and Valencia with 15 unfilled vacancies surpass Castilla y León, a community that has an added difficulty. Pablo Oyáguez, pediatrician and president of the board of personnel of the health area of Burgos points out that 10 years ago the counseling merged the work category of hospital pediatricians and primary care, which has caused doctors to rotate little in primary school when They are forming. So "it is predisposed to future pediatricians to opt for the hospital."
The counseling assumes that attracting specialists in the territory is an autonomous competence and that they will improve the conditions to encourage doctors to fill difficult positions. "In the end or there are more doctors or those who work more", comments the counselor Antonio María Sáez, who recognizes that this is a problem that affects the entire country and that is why he has requested an extraordinary call from MIR to the Ministry of Health. This year 433 places have been called in Spain, but for each "two doctors who retire, one is being trained", regrets Oyáguez. Meanwhile, those who remain survive, overwhelmed.