The situation of Primary Care in Spain is “critical”, but in the case of Madrid it is “especially bloody”, say the medical unions Doctors in Madrid and Cantabria are on indefinite strike and those in Navarra threaten to join the strikes The places for Family Medicine have risen 36% nationally, but in the Community of Madrid they have fallen by 2%, denounces Darias Emergency doctors from health centers are on the warpath in the Community of Madrid. They are not the only ones. Primary Care physicians in Cantabria and their colleagues in Navarra have also begun to take action against a situation that the convening unions consider “critical” due to staff overload and poor working conditions. What is happening? The problem, they say, is widespread throughout Spain and has worsened after the pandemic. There is a lack of family doctors. That’s a fact. Although the situation in Madrid is even worse, as has been revealed with the “chaotic reopening” of the emergency centers, the medical associations denounce. No autonomous community had kept these services closed for so long and the Community of Madrid has now reopened them without hiring more staff. Before the pandemic there were 360 doctors for 80 out-of-hospital emergency posts. Now there are 228 doctors, explains María Justicia, president of Primary Care of the Association of Doctors and Higher Graduates of Madrid (AMYTS), organizer of the strike. What happened to the rest of the staff? Many were relocated to services that are still operational, such as the rapid intervention vehicles or the coordination center. So the numbers don’t add up, says the doctor. Voluntary shifts or video consultations To make up for this lack of personnel, one of the proposals by the Madrid Ministry of Health was to offer voluntary shifts to family doctors in health centers, but “at 19 euros gross per hour”, the answer was not was the expected. “If they paid them fairly, for example at the price of firefighters, who charge more than double, the situation would change,” acknowledges Ana Giménez, technical secretary of the State Confederation of Medical Unions (CESM). 🏥 @SaludMadrid is going to implement a transitory organization model for the 24-hour Health Centers.✅ It will keep the 80 centers open with 46 fixed points with a doctor and a nurse, and 34 with two nurses and a video consultation with a doctor.https://t.co /qQY2AiIMU3— Community of Madrid (@ComunidadMadrid) November 7, 2022 The latest proposal by the Government of Isabel Díaz Ayuso has been to opt for video consultation in those centers where it is not possible to physically have a doctor. So that 46 points will have a doctor and a nurse, and the other 34 with two nurses and video consultation with a doctor. “A transitory model of organization of health centers 24 hours a day until the situation of labor conflict generated in the first 10 days of reopening of this network is redirected,” the Community announced in a press release on Monday. A “nonsense”, considers María Justicia, because “how are they going to explore abdominal pain, chest pain or a headache? Emergencies cannot be done electronically, they have to have a doctor,” stresses the AMYTS spokeswoman. Ayuso accuses and Darias responds According to the president of the Community of Madrid, the problem is, apart from “deep political activism”, the lack of doctors in Spain and “the Government does nothing, it is more busy pardoning, releasing prisoners of ETA and to continue empowering themselves,” Ayuso accused in an interview on El Programa de Ana Rosa. “Doctor who is unemployed, doctor that this very afternoon I hire in the Community of Madrid”, she has said. The Minister of Health, Carolina Darias, was quick to respond: “Given Mrs. Ayuso’s outbursts, some convincing and devastating data.” Places for Family Medicine have risen by 36% at the national level, but in the Community of Madrid they have decreased by 2%. “The Primary Care emergency services have increased by 30% since 2018, while in Madrid the staff have decreased by 38%”. Much less has been invested in Madrid, says Darias, although the truth is that the lack of Primary Care doctors is a problem that affects all of Spain. In La Rioja, sources from the Ministry of Health acknowledge NIUS, it is also a problem due to the high percentage of doctors who are retiring, but “our 15 continuous assistance points, except for unforeseen situations, function normally and, of course, It does not occur to us to open one if the doctor is not there,” they tell NIUS. What is the situation in other autonomous communities? In Cantabria, for example, Primary Care doctors began an indefinite strike on Monday as a protest against the “precarious” working conditions and an increase in aggression. In Navarra, the medical unions have given room for negotiation, but the threat of strikes is on the table. More patients, fewer doctors In Galicia, the situation of Primary Care is not good either. The saturation of health centers has gone from being punctual to becoming chronic. “Clearly we have worsened with the pandemic,” says Jesús Sueiro, spokesman for the Galician Association of Family and Community Medicine (AGAMFEC). There is more demand from patients and fewer doctors to attend to these queries. “In the centers there are two situations: either the doctors have unaffordable agendas, between 40 and 50 patients a day; or that there are waiting lists to access the family doctor that can exceed ten days, ”he explains. “There are patients who now come to the clinic for a cold, when they did not do so before. To this must be added chronically decompensated patients due to lack of attention during the pandemic and the great ticking time bomb that is mental health. The care of people with disorders, stress and anxiety has multiplied”, says the doctor. No replacement for retirees in a “precarious” Primary Care The problem is that there are not enough doctors to meet that demand. There is no one who can replace all those casualties and replacement for those who retire. “What has happened is that there has been a total lack of foresight. We have been warning for ten years that this was going to happen because the average age of doctors was very high and an avalanche of retirements was going to come”, says Jesús Sueiro. There are no doctors to throw away because, he explains, there are no doctors who want work in precarious Primary Care. “As much as we increase the number of places, if we don’t increase the quality of the contracts, the situation is not going to be solved”, he predicts. “Doctors choose first to work in a hospital, in mutual insurance companies or in private clinics. They even prefer to go abroad to work because they have better conditions than in Primary Care”. A “moribund” Primary Care where those who can leave A situation that is also repeated in Andalusia. “In Madrid, the situation has become entrenched, but it is a widespread problem throughout Spain, acknowledges Rafael Gómez, from the Seville Medical Union. “Primary Care is dying, with health centers, such as Lebrija, for example, in the that there must be 15 family doctors, there are only six and of the four paediatricians, there are only 2. The doctors leave because of the working conditions they are in, with strenuous hours, appointments every five minutes, stress, fatigue… .”. Even in the Basque Country, one of the communities where Primary Care doctors are better paid and where they have better working conditions, they complain of “an enormous” lack of professionals, accentuated because working conditions “are not good and those who can they are leaving,” says Mabel Arciniega, general secretary of the Euskadi Medical Union. How much does a family doctor earn in Spain? There is a lack of Primary Care doctors throughout Spain and not because there are no trained professionals, but because either they go to the regions with better conditions (Murcia or the Basque Country) or they directly go abroad , coincide from the State Confederation of Medical Unions. Family doctor annual salaryJobtedAccording to employment portals, the average salary of a family doctor is about 43,600 euros gross per year, about 2,360 euros net per month. A base salary that, being civil servants, is set by the Ministry, although later each autonomous community establishes some bonuses and job improvements in the form of salary or hours, union organizations explain to NIUS. In fact, according to the Jobted portal, Madrid is one of the least paid. A salary that in France can be multiplied by two or by more than three in Germany. To the lowest salary we must add that in the Community of Madrid life is more expensive than in other places in Spain. Family doctors come from spending some negative years in terms of salary. Between 2009 and 2018 they lost an average of 17% purchasing power. Slightly above that average were those from Madrid, which with 17.4% were the rooms that lost the most, according to the comparative report by Esteban Lifschitz and other authors that the Ministry of Health cites as a reference. In addition, Madrid is one of the communities where doctors work 37.5 hours a week, compared to 35 in the Basque Country, Andalusia and six other regions. Spain, Europe’s pool of doctors “Spain is the pool, it trains doctors because system is very good in all specialties, and Europe collects them because the working and economic conditions have nothing to do with Spain, in general, and in the Community of Madrid in particular, where they have dedicated themselves to mistreating doctors and mistreating Primary Care”, considers María Justicia, president of Primary Care at AMYTS. 📍This Monday we gathered in front of the Ministry of Health to say NO to the Out-of-Hospital Emergency Plan🗓This Monday the strike began, because the cuts in Health professionals kill pic.twitter.com/Aqbkqvv7qR—Doctors and TS-Madrid ( @amytsmedicos) November 7, 2022 Spain is in a “critical situation” but in the case of Madrid it is “especially bloody”, agrees Ana Giménez, CESM’s technical organization secretary. “Aragon or Murcia treat their doctors much better than Madrid and they have half the problems.” “That there is a lack of doctors is the mantra that they always repeat, but they never stop to think about why doctors from the Community of Madrid leave for other neighboring communities,” they also point out from AMYTS. As explained by María Justicia, investment in Primary Care means “health”. The WHO, says the expert, recommends investing 25% of the health budget in Primary Care, although in Spain, on average only 14% is invested and in Madrid the figure does not reach 11%. If we add to this the “nonsense and chaos” involved in trying to cover the service of 78 centers with the same staff as there were previously for 40, summoning the professionals with a message on their cell phones the night before, dividing the teams and moving doctors unilaterally miles away and from one day to the next, it is “normal” that there are people who unsubscribe due to anxiety because they are unable to carry out their work in these conditions. “They are not casualties, it is that in Madrid we are about to explode,” warns the doctor.