Medical faculties and lack of specialists | Society

Medical faculties and lack of specialists | Society

To the Spanish health service there are many faculties of Medicine and he lacks specialist positions. This would be, with a brushstroke, the summary that representatives of the Forum of the Medical Profession have done this morning and that reflects the imbalances of a system that should be a continuum from the entrance to the university (the famous numerus clausus that makes entering Medicine require one of the highest grades of selectivity) to practice in hospitals and health centers and whose organization depends on the ministries of University and Health and the autonomous communities.

The diagnosis is based on data, such as those presented by Laura Martínez, president of the State Confederation of Medical Students (CEEM). 221,470 doctors are active in Spain. which yields a rate of 384 per 100,000 inhabitants. This is 12% more than the European average, according to Eurostat. And there are 44,758 students in the 42 faculties of Medicine, which in theory would almost reach to cover the next retirements (48,000 in a decade).

But the problem is that between the university and clinical practice there is another step, that of training as a specialist (the MIR, internal resident doctor). And access to this phase depends on the places (the teaching units) that are in hospitals and health centers. Depending on these are fixed the places available. And the data "are alarming." Only in 2018 14,466 people applied for the exam (half of them just graduates), but 6,513 places were called. Not even if only the graduates of the last year presented themselves would there be places for everyone, but to those 7,000 recent graduates it is necessary to add other doctors who failed in previous years, physicians who want to study another specialty, and graduates abroad who come to obtain the Spanish title. The result is that of 14,466, 69% had a degree from a Spanish university (9,925). Of these, 5,919 obtained a place. 4,006 were left out, practically half of those who were left without a place.

This year the demand for places has grown by almost 1,000 people, and the offer has only risen by 260, so, after the MIR exam on Saturday, this stock market will increase, said Pablo Lara, president of the National Conference of Deans of the Faculties of Medicine. Part of these professionals go on to practice without specialization (almost all in the private sector) or seek to work outside.

Before this funnel, there are two solutions. The first, reduce the number of medical students. The second, increase the MIR places. But neither is easy.

Regarding those who start the race, their number has grown from 6,244 to 7,042 (12.7%) in the last 10 years, said Lara. In part, by the creation of new faculties, the majority small, whose number has gone from 24 to 42 (50% in that time). Of those 14 new, 8 are private, which have grown from 2 to 10 in a decade.

In both parameters (students and centers) Spain exceeds the recommended maximums. It is the second country in the world in number of faculties, with a rate per million inhabitants of 0.95, practically twice the 0.5 recommended by the World Health Organization, and only behind South Korea, which has a rate of 1. With respect to students, the average rate of graduates per 100,000 inhabitants in the OECD is 12.1, one tenth above the recommended value. Spain has 13. This would force to close some. But this will not be the case in the short term: there are three (universities in Alicante, public in Navarra and Deusto) about to receive approval.

There is another indicator that shows the over-dimensioning of Spanish universities. In the most prestigious of the United States, the promotions do not have more than 200 people (165 in Harvard, 104 in Yale). In Spain, the Complutense, the Autonomous University of Barcelona and the Valencia University graduate at 290 per year.

It is not a question of adjusting to parameters because, yes, Laura Martínez has warned. Having so many faculties is not justified because, if they are in the same locality, compete for the resources of hospitals, where students have to do internships, so they create coordination problems in that aspect and quality in the teaching they receive. In addition, it is not economically profitable, An average faculty of 173 students (the average in Spain) costs about 6 million fixed costs, plus about 6,000 per student per year, said Lara. And, in the immediate future, there is another problem in sight: the number of teachers will fall by more than 30% in all segments by 2026, with a drop of 43% among the permanent, the most experienced.

On the side of specialization, you have to look for teaching units and increase the number of places, but always keeping in mind what the future needs will be (it does not make sense to train 100 thoracic surgeons if you need 10, you have given as an example Pilar Garrido, of the General Council of Specialties). In addition, more MIR supposes that the tuores have to combine teaching with the students and supervised the future specialists.

The map of needs and resources presented last week by the Ministry of Health suggests that there is hardly a deficit of 3% this year, but above all because they are poorly distributed. The student president said that incentives were needed, but stressed that when they received consultations the majority was about conditions such as the time for consultation on the waiting list, and very few for salary.

In the end, "this diagnosis we had already made," said the president of the Medical Organization Colegia, Serafin Romero, "but now they need to pay attention to us". "There has been much progress since when we were 21,000 applicants for 1,200 places," said the doctor, who insisted on the idea that you can not go back.


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