The majority of communities irregularly hire doctors without the MIR | Society

The majority of communities irregularly hire doctors without the MIR | Society

The health councils of most of the autonomous communities of Spain sign "systematic and irregularly" temporary contracts to doctors without specialty qualifications (MIR), mainly for emergency and primary care posts, as warned by the main state and autonomous medical unions. The regional governments affirm that these are "exceptional" measures -work of weeks or a month- to cover holiday leave and the strong demand of doctors in areas of difficult coverage. The unions say that it has been a common practice for a long time, in Valencia for 15 years and in the Canaries 21. The unions say they have been warning of this problem and the councils do not adopt measures to solve these "caveats". Seven of the 17 autonomous communities consulted by EL PAÍS deny that these practices are carried out and three that have been carried out in an exceptional manner.

The Health Minister of Castilla y León, Antonio Sáez Aguado, presented the community health groups a document dated last Friday and signed by the director of regional health management in which he proposes the hiring of graduates without specialty. After the proposal, the medical collectives have shown a resounding rejection. The Forum of Primary Care Physicians, in which all the organizations representing this specialty participate, has called a press conference on Thursday "to expose their strong opposition" to this type of contracting. The document presented by the Leonese Council refers to contracts for primary care, emergencies and emergencies. The duration of these "eventual appointments", cites the text, will be of six months extendable "if the circumstances that originated the appointment persist".

Spanish legislation states that to be able to practice in public health, it is mandatory, besides being licensed in medicine, to have a specialist degree, which is obtained after three or four years of tutored training in hospitals, the famous MIR, interim doctor resident. However, the law provides that in "extraordinary" circumstances, hiring without such a title can be justified with the objective of not ceasing to provide medical services. The unions stress that the Administration makes use of this legal "trick" to illegally hire graduates without the MIR, non-community professionals without an approved degree and physicians who work in a specialty for which they are not accredited.

"It's more than an irregularity. It is an illegality. The law demands the opposite, except in exceptional cases in which these circumstances can be understood, "explains Tomás Toranzo, president of the State Confederation of the Union of Physicians and Honorary President of the Spanish Society of Medicine of Emergencies and Emergencies. The legislation, present in a decision of the Supreme Court, does not define to what type of exceptional circumstances it refers or to the duration of the same. Toranzo is also vice president of the Medical Association of Zamora, a position that led him to denounce that the council of Castilla y León was hiring doctors without MIR because "they did not find regulated professionals" and "the staff had an excess of hours worked." In the public health system, health personnel have a limit of some 3,400 working hours per year. "Many doctors are overburdened and when December arrives they have already completed their quota of hours and by law they can not work anymore," Toranzo explains. The unions and communities allegedly affected have not provided corroborated data on the number of irregular hirings.

One of the solutions proposed by the unions is to increase MIR places and properly manage vacations. This February, The Ministry of Health will remove 6,000 places for 16,000 applicants. "Every year there remain about 10,000 qualified doctors who can not practice in public health and need to earn a living," explains the unionist.

The Council of Castilla y León argues that "there are various judicial pronouncements that support these situations of exceptionality, including an old Supreme Court Judgment" (to which it does not refer) and which are similar to the contracts that were carried out before "The lack of specialized doctors" in rural health centers of Puebla de Sanabria and Carbajale (Zamora). "Once some professionals who were on sick leave have joined, urgent care is provided from January 10 with the family doctors of staff", has argued to EL PAÍS a spokeswoman of the Health Council of Leon.

The president of CESM says that, although these contracts do not represent a high percentage, "it is a symptom of the deterioration of the health system, especially in primary care. We are seeing it in the mobilizations of the sector in Catalonia. Primary care professionals do not get everything they are asked and the administration, to solve this, resorts to the easiest: to hire whatever, "the representative argues. Toranzo adds that this problem does not have to affect the safety of the patient, since these contracted "do not stop being licensed in medicine". "Better that there is a doctor without MIR that the ministries close consultations due to lack of personnel," he says.

Toranzo says that this specific case in Castilla y León led them to investigate what was happening in the rest of the communities and discovered "a reality throughout Spain that flagrantly ignores the law". In Andalusia, Extremadura, Valencia, Catalonia and the Canary Islands, they say, these contracts are signed on a regular basis. "In Almería and Huelva they have been making three-month contracts in the same circumstances for three years. If you continue investigating, it turns out that since 1998 it has been doing systematically in the Canary Islands. There is even a resolution of the then president of the Community, Román Rodríguez, which supports that you can resort to doctors without specialty, "Toranzo explains.

Most affected communities

The Andalusian Medical Union affirms that these cases occur in rural areas that are unattractive for doctors with specialty. Believes that the Administration should encourage these destinations. "It is the counseling that should anticipate these exceptional situations. To which they are united that around 20% of the paediatricians enter without specialty because of the strong demand of these professionals ", comments the Andalusian union president, Rafael Carrasco.

In Valencia, of the 800 pediatric beds that exist, 193 are occupied by doctors of general medicine, according to data of Andrés Cánovas, general secretary of the Valencian Society of Neuropediatrics and president of the Medical Union of the Valencian Community. In addition, he points out, 40% of the doctors at the health care points are professionals without MIR. "We have been warning of this problem for more than 15 years and nothing is done. We could take the case through the courts, but we are aware that these doctors provide a necessary service, "says Cánovas.

Canarias is one of the communities with the most irregular hiring. According to the union, 80% of those who cover casualties are doctors without MIR and, of them, 70% are non-community professionals from Ecuador, Cuba and Colombia. 35% of stable pediatric beds are not headed by a specialist. "Since a few years ago, gynecologists, traumatologists and radiologists are beginning to be lacking. In La Gomera, for example, there is a doctor who, despite waiting for his specialty to be homologated, is practicing as a surgeon. If the patients do not ask, they do not know that the person who operates them is not legally accredited to do so, "says the deputy secretary of the Medical Union of Tenerife, Levy Cabrera.

"The Canary Islands have ceased to be an attractive destination for work. Within about five years, with the increase in retirements, the situation will get worse. The Administration knows or should know and continues without increasing the places of residence, "says Cabrera. It also emphasizes that these doctors without specialization do not stop being "the people who are taking the chestnuts out of the fire" and those who lift the burden on the doctors who do have the accredited degree.

Judges for Democracy affirms that the exceptionality to which the law refers does not cover as many cases as the trade unions denounce, for example, it does not work for the neurologist without approval in La Gomera or the high percentage of doctors without MIR who work in Valencia. It does emphasize that there is complementarity in the cases of general practitioners who practice as pediatricians. They emphasize that they are reportable practices through administrative judicial processes. "An exception can last three months, but not five years. I do not have records of similar cases, but the unions could open a judicial process, "explains a spokeswoman for the professional association.


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