On servility and the MIR profession

The group of Internal Resident Doctors (MIR) has reappeared in the media. The last time was as a result of the mobilizations carried out by the MIR in the summer and autumn of 2020, to demand better working conditions for one of the most precarious groups of the National Health System in different parts of the State, including Madrid Y Catalunya. This time, it was in Espejo P├║blico, Susanna Griso's program, where a recent graduate explained the reasons why she decided not to take the exam to access the specialization via MIR.

From the first moment of the interview, the objective of the interview is clear: "Why do fewer people show up for the MIR exam in the middle of a pandemic, when they are most needed?" The tone is one of false surprise, indignation, blame, and, ultimately, public signaling of an alleged lack of responsibility of recent graduates and graduates.

After the interviewee rightly pointed out the exceptional situation suffered by people who have finished medicine during 2020, Susanna Griso's response is clear: "Now that you are needed, excuses are not worth it." And he concludes: "The experience of working for a year with Covid, with hospitals totally saturated by the pandemic, I think it's worth living it, right?" Joining the conversation, liberal economist Daniel Lacalle comments: "I am very sorry, but 12 hours a day studying and working at the same time we have all done it."

And not everything ends there, it is not only arrogance and continuous lack of respect, but Susanna Griso misrepresented the job situation of the interviewee, stating that she worked for a private company when in fact she was working for a public one.

This interview hides the real problems with MIR training in Spain. The problem of the lack of doctors in the National Health System is not based on the individual choice of recent graduates. It is a structural problem that has multiple reasons, and all are much more complex to assume politically than individual responsibility:

  • The statement that gives rise to the interview, which implies that this 2021 is the year that fewer people present to the MIR in the last ten years, is false. This year 13,638 people took the exam, a higher number than previous years, as in 2017, in which there were 13,439 applicants.
  • What has decreased is the ratio of candidates for each place offered, which is 1.7, since 7,989 places are offered. This means that, even if more people had taken the exam, those who would eventually end up accessing the MIR training would be the same. This year 5,649 doctors, of which a high percentage are recent graduates, will not be able to undertake MIR training, and therefore will not be able to enter the National Health System to work, since the MIR is a mandatory requirement to work as a specialist.
  • The MIR cannot be, by law, structural personnel, neither of the primary attention centers nor of the hospitals. The MIR contract, whose regulations were established in Royal Decree 1146/2006, establishes a labor-training contract, and not just a labor one. Unfortunately, in many cases this training was not given properly, a situation that the pandemic has aggravated.
  • Contrary to what Susanna Griso and the Espejo P├║blico team may think, working during the pandemic has not been an experience worth living. The pandemic has caused an organizational chaos that the MIRs, like the rest of the health personnel, have paid for by doing strenuous working hours, and having to live in situations that are not desirable for anyone. The MIRs have become cannon fodder, easy to exploit because they are temporary staff, with little unionization and collective organization. To the days of up to 86 hours a week (and sometimes more), a worsening in the supervision of residents has been added given the care overload. The management of a pandemic situation cannot fall as the presenter suggests in "going through the hoop" and making up for the deficits in medical bags. It is not the people in their first year of specialized training who have to go alone to the front line of battle, for a matter of patient safety and the care of our MIRes.
  • According to WTO calculations, more doctors are retiring than are trained each year. Furthermore, in the last ten years, the exodus of doctors to other countries has not stopped growing, reaching more than 30,000 certificates issued to work abroad in the last 10 years. The lack of personnel in the bags that they suggest during the interview is an accumulation of years of contracts of days, weeks, months, substitutions, 40% contracts and high mobility conditions within the same Autonomous Community. All this entailing a marked vital instability. The MIR collective has been one of the most affected by the pandemic. The lack of protective equipment, added to the long working hours, and the commented organizational chaos, have made the percentage of infections very high compared to the general population. As the colleague points out in the interview, the MIRs also have families at home, and a pandemic does not justify exploitation and exposure to risk situations.
  • The applicants to the MIR 2021, in addition to losing the practices in their last year of training, have had to hold an opposition in very adverse conditions. The blame to which they are subjected is intolerable. Vocation cannot serve as an excuse to destroy the dignity of the medical profession. Studying twelve hours a day and working at the same time is an exploitative situation, in which good training is not ensured, nor is mental health guaranteed. No one should be criminalized for deciding not to run for an opposition under these conditions, least of all in a pandemic in which levels of stress and anxiety at the population level have skyrocketed.

Let's leave our young doctors alone. Let's stop blaming a group that has been mistreated and held excessively responsible for the shortcomings of the system. First heroes and now villains, at no time have they wanted to be neither one thing nor the other.

If we want there to be more doctors in Spain, let's improve working conditions, increase quality training places, ensure decent job opportunities by ending precarious contracts, and, ultimately, we bet on quality Public and Universal Healthcare.


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