Medicine is probably one of the most on-track professional careers since the students cross the door of the faculty. Six years of career, just under a year of study for the MIR exam and a minimum of four years of specialty. Traditionally, these times were filmed, but this year – due to the covid-19 pandemic – the chose of Specialized Health Training places (ESF) has been fraught with controversy and delays. And the most worrying: this delay in choosing a place is causing deficiencies in hospitals throughout Spain, as observed by the professionals themselves.
Let's do a quick summary of the situation. Although this year the examinations for the FSE were carried out with complete normality in January, the terrible coronavirus stopped the traditional process of choosing a place and the subsequent ones decisions of the Ministry of Health in this regard came loaded with controversy. From the Administration, it was indicated that the election of place would be carried out telematically (normally, it is in person at the ministry), something that produced great uncertainty for many potential specialists, who considered that it could harm them and condition the rest of their lives. . But not only that, but students and unions, in addition to asking to return to the traditional system, denounced a lack of transparency in the processing of academic records. Finally the Supreme Court suspended the award of exclusively telematic places and it will be held in the coming weeks as in previous years.
The dilation of the process by the covid-19 —and the dimes and diretes between the Public Administration and potential specialists— has caused a gap in the number of residents in hospitals. In the month of May, when the seniors finished their specialty, the new ones should have entered the health centers, but it won't be like that until almost October. Thus, it is occurring a gap in the number of professionals in training that will last five months.
The MIRs, apart from their training, fulfill a very important function for the health system: the guards. Residents carry out these 24-hour days of uninterrupted work, in which a occupancy overhead, as, missing the first year, the rest are filling those gaps, according to the professionals themselves. This increase in work can affect both its performance and training in the specialty.
"It affects especially those of internal medicine or pharmacology, which are what make guards general. Approximately, they do four more a month, because they have to fill the position of those who should have entered. Which supposes a considerable increase in guards ”, he explains to El Confidencial Paula, a second-year resident of a Cantabrian hospital.
There is an increase in the guards, some residents arriving to make two weekly, which is "an exaggerated physical and mental fatigue"
This increase in guards that is taking place in many health centers can cause a resident gets to do up to two weekly, which supposes “a exaggerated physical and mental fatigue"Explains the young woman, who is suffering from her own meat. “It also implies a loss of rotations in the services where we are trained, by releasing the guard. Or even not let go of the guards and do 24-hour work periods, plus another eight of the service in which we are ”, explains the doctor.
"This has a repercussion for both us and the patient, finding ourselves under such great pressure. In the end, the quality of care also decreases. Not because we want to, but when a person cannot cope with his life, he does not attend as when he is fresh as a lettuce ”, he regrets.
From the General Council of Official Medical Colleges (CGCOM), Gabriel López Ordoño El Confidencial relates this situation: “The residents, in exchange for training, They are providing assistance in the emergency department of the hospitals to be covered. They are posts that they should be covered by attachments, that they are better paid than residents and with more consolidated labor rights. But hospitals often make them fall on residents because if their labor rights are trampled on them, as is happening, they are silent for fear of the final evaluation or that they will get annoyed; and if you try it with an attachment, which takes longer, it probably won't go through the hoop. ”
López, who is the national representative of the Board of Hospital Doctors of the Collegiate Medical Organization, also believes that “the managers of the hospitals and the teaching committees are looking forward to residents coming to their services, but not to train them or do scientific work, but to be able to do more healthcare activity on behalf of the residents ”.
MIRs: cheap labor
In this sense, Gabriel del Pozo, Secretary General of the State Confederation of Medical Unions (CESM), explains to this newspaper that “in some centers there is bad habit of using residents as cheap laborAs if they were hospital staff professionals, and what they do is pass the guards over to them. ”
In an ideal situation, Del Pozo explains that this gap between professionals who have already finished the specialty and those who should enter should not affect service: “The first-year residents are personnel in training who cannot do anything in their guards, but are supervised. In any case, what they do is give more work to the deputy who supervises them. In principle, the first-year students are the ones who need the most tutelage, they are starting their training and they only come with the knowledge of the career ”.
But in hospitals, as is the case of Paula, where this overload of work is taking place due to the gap between those who have already finished the specialty and those who enter, the secretary points to “Poor service management”. "It really shouldn't be like that, there should always be a sufficient number of attachments so that the resident's absence was not noticeable, and less than the first year, at the time of the guards," he says. Although he acknowledges that this impact of guards on residents "is something that comes from before and has been exacerbated this year because the first-year come later."
Risk to patient and doctor
The member of the Medical Council points out that, although the residents are "tired and exhausted" after this overload of work, "They keep quiet and take on the job, against their health and at the risk of the patients they serve" “It is perfectly demonstrated that the rate of medical errors increases with on-call hours, fatigue and exhaustion. In addition, even at the cost of their health, a young resident is silent on duty if his guardian or head of service tells him to stay.
“Undoubtedly, when you have had a bad guard, you are tired or exhausted, you can miss a detail such as an allergy, a previous illness or a treatment that is being followed; something that can condition the therapy that you are going to give to that patient, ”says López. "Medical errors are conditioned by working hours. In fact, American scientific journals recommend not operating on patients at dawn, unless it is life or death. In problems that can take five or six hours, it has been shown that they do not pose a risk to the patient, but operating them at dawn with an exhausted surgeon poses more risk to the patient than delaying the operation. And yet, 24-hour guards continue to be made, ”he adds.
Del Pozo agrees with the resident that "psychological conditions of the person who is on duty one day, another one on rest and one on duty they are not the most ideal to develop a job that requires being 100% concentrated. "
In addition, we must not forget that this decline in professionals in the system may be aggravated by covid-19. “The situation can be worse considering the emotional and psychic overload already brought in by the contracted professionals and the MIRs who have been working during the pandemic. This has generated significant stress. "
Illegality in hospitals?
Also, the secretary points out that there would be a illegality in those services where more than five guards are performed per month, the maximum established by European legislation. In this sense, it encourages residents themselves and services to publicly denounce the shortage of staff.
"The system does not have to be maintained by MIRs, the system must be maintained with the contracted personnel. If the templates are insufficient, the templates will have to be increased and we must make good payments, ”he concludes.
From the Ministry of Health, with which El Confidencial has contacted, blame this situation on the autonomous communities, as the powers are transferred. But they do not answer other questions about a possible failure of the MIR as a training system, the possibility of carrying out inspections to control these vices or the possible abuse of using residents as cheap labor.