2023-11-18 17:15:00
More than 2,900 internists have gathered at the 44th National Congress of Internal Medicinewhich has been, according to the president of the Spanish Society of Internal Medicine, Juana Carretero, “a success at the level of assistance, organization and science.” Despite this climax reached by the specialty at the congress held in ValenciaCarretero has the future of the specialty in mind, remembering that in 10 years “they will retire between 20 and 25 percent of internists That they are working”. Due to this situation, the internist opts for “resizing of resources that they currently have.”
In an interview with Medical WritingCarretero also highlights that the leading role of climate change on people’s health is being addressed by internists, through “the creation of a SEMI’s own strategic line to face this new scenario.”
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Juana Carretero, president of SEMI, has defended the “creation of SEMI’s own strategic line to confront climate change”
What assessment do you make of the 44th SEMI National Congress, held in Valencia?
This Congress has been a success in terms of attendance, organization and science. I think that scientific success has even had more influence than organizational success. The work of the working groups throughout the year to disseminate and create practical material for internists means that people, residents, assistants and older people have the need to come to be educated, trained or updated in the congress. Tools are offered for day-to-day management. That feeling of belonging that more and more internists have today to the SEMI has caused 2,900 people to gather.
The program has included many new features, such as artificial intelligence, which is increasingly assumed as their own and professionals feel more comfortable talking regarding it. There have been many ultrasound tables and workshops. Not only are there workshops on general management of ultrasound, but they are aimed at thromboembolic disease and heart failure, so that it can be practiced in hospitals. The updating of day-to-day needs has made people more eager to come to the congress. Valencia has helped a lot and so has time.
The Congress has highlighted the role of the Internal Medicine specialist in addressing the challenges that care for chronic patients will entail. Does the specialty have the necessary resources and training to adapt?
Internal Medicine is amply prepared to approach chronic patients, because it has always been treating this profile of people. A chronic patient has multimorbidity, living with two or more chronic diseases at the same time. Thanks to economic and social improvements, innovation and training, diseases that were once fatal are increasingly allowing people to live longer. Internal Medicine is used to dealing with these patients, but now new conditions of complexity are added that were not so assumed before, such as the risk of social exclusion due to all the economic conditions that exist now. This aspect is associated with the risk of malnutrition, which has a greater influence on the prognosis of patients, and alcohol abuse, so normalized by society.
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Carretero has considered that chronicity strategies are not well implemented “neither at the national level nor at the regional level”
65 percent of Internal Medicine Services have a complete chronic patient care program. This means reaching 28 percent of the population with these needs. Chronicity strategies are not well implemented, neither at the national nor regional level. Although the Services have these consultations, the fact that they are not well implemented makes it difficult to reach everyone.
“Chronicity strategies are not well implemented, neither at the national nor regional level”
Will climate change modify the role of Internal Medicine?
More and more is learned in Internal Medicine regarding this scenario. Until recently, no one thought that these heat waves would influence the prognosis of lung diseases, heart failure or kidney disease. Right now it is known that for every degree and a half that the temperature rises, mortality from COPD and hospitalization of those people who have multimorbidity increases.
The SEMI is currently developing a strategy with eight internists who are going to lead a project initially, in collaboration with the Ministry of Health, to create a strategic line on how climate change influences. It is not so much pollution, but food safety that affects diseases. It is a line in which SEMI is excited. During the congress there was a first work meeting and this initiative will have many results. You can’t turn your back on this. It is November and enduring temperatures of 25 degrees is not normal.
The Ministry of Health has launched a line of work in this field and SEMI was asked for two representatives to work in the SEMI multimorbidity group. As a result, SEMI’s own line has been created, directed by the vice president of the society, Montserrat Chimeno. It is important that all this information is transmitted to patients. The professor of Internal Medicine at the University of Córdoba, Francisco Pérez, is another of the personalities who is involved in this process and gave the inaugural conference on whether it should be change your diet to save the planet.
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The president of the SEMI has not yet received any response from the Ministry of Health in relation to the recertification process.
SEMI launched a program a year ago to address recertification. Has any proposal been received from Health?
Currently there is no answer. The SEMI began to work actively with the Federation of Spanish Medical Scientific Associations (Facme) in this sense, thinking that it was positive, in view of the slowness with which the ministry’s proposal was going, to develop its own recertification process. Although there are transversal competencies, each specialty must have specific competencies related to the specialty. The SEMI has already identified them and the recertification process has been developed.
Until now it has not had much of a response because since it does not go hand in hand with Health and since it is not the definitive proposal, many times the internist does not feel the need to have this recertification. It was recently agreed by the board of directors to continue with the process, but always keeping in mind that once the ministry begins this process with Facme, SEMI will be on the side of the institution, supporting this initiative, providing the necessary experience and skills. .
During his speech at the opening of the congress he highlighted the specific training areas (ACE). What specific areas do you intend to develop?
SEMI is working on it. The company, following the proposal of creation of the Emergency specialty, presented some allegations. SEMI has always advocated for an area of training in Emergencies and other areas of knowledge. It was a surprise for SEMI that Emergency Medicine came out as a proposal for a new specialty. Internists who already work in the emergency room need recognition. Although it is not the most common, an Internal Medicine specialist may have the need to work in the Emergency Room. You must be clear regarding what that step is. After the proposal was announced by the ministry, the SEMI requested four years of specialty and then two years to access Emergency Medicine.
Right now, once the ministry’s proposal for the creation of this specialty has been published, multiple allegations have arisen from all scientific societies and almost all autonomous communities. They are realizing the problem of devising a specialty at the logistics and personnel level. The simplest thing would have been to recognize the work that these people do and create an ACE that might be accessed from Family Medicine, Internal Medicine and Intensive Care. Finally, it is not known whether the bill creating the Emergency specialty will be completed or whether it will have to be backtracked or reconsidered. The SEMI proposal is to carry out an ACE.
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The president of the SEMI has explained that work is already being done with the ministries to present new ACEs.
Have you already spoken to the Ministry of Health regarding it?
The company has submitted the ACE proposal to the ministry and is working with the departments to obtain the letters of support necessary to send it. The SEMI expresses its disagreement with the way in which the ministry should be notified. If to present an ACE the support of seven ministries is needed, if this is not achieved it will never be possible to submit a proposal to the ministry. Health will never know what internists think. It is a trap proposal, the proposals should be allowed to be presented and then debated in the Interterritorial Council, deciding what to do. This cannot be conditioned on the need to have seven letters of support.
“If to present an ACE the support of seven ministries is needed, if it is not achieved it will never be possible to submit a proposal to the ministry”
With Infectious Diseases, SEMI has made calculations. There may be approximately 550-600 internists working temporarily in Infectious Diseases. It would not be necessary to create teaching units because these people are already working in those Services. Simply by accrediting these people in the ACE of Infectious Diseases, the need would be covered. Other specialists would not have to be created. The problem is resolved and covered by colleagues. It would be easy to recognize this and say that when an Internal Medicine resident finishes, his specialty following five years can mean, with two more years, the acquisition of those skills that people who have spent many years dedicating themselves to Infectious Diseases now have.
How will the retirement of internists in the short term affect the specialty? What measures do you think should be reconsidered to avoid a shortage of internists?
Right now the ratio of internists per 100,000 inhabitants is 8.4. There are territories like the Valencian Community that is at 5.7. The great geographic dispersion in some areas makes it impossible to reach all of these people. In 10 years, between 20 and 25 percent of working internists will retire. This year the ministry’s offer of Internship places has increased to 11 more. It is not enough, people who train as doctors take six years, plus the year they are preparing for the MIR and the five years of specialty increases to 12 years. At that moment there will be a impressive shortage of specialists.
It is good that more places are created, but it is also good to resize the resources we have. That there are other colleagues who work with the internists who might dedicate themselves not to the acute care of the patient, but to performing diagnostic tests, outpatient consultations, etc. It is regarding sizing the resources to be able to assume that care burden that one has. It is important to think that in 10 years there will be 20 percent of internists who will no longer work, so this scenario needs to be prevented.
Pedro Sánchez has recently been appointed as the new president of the Government of Spain. What would you ask from the SEMI to the future Minister of Health?
As a priority, the SEMI defends that it should not fragment the MIR system, a symbol of excellence, is endorsed and solvent. It allows equity so that any doctor in Spain, whether trained in the Canary Islands or Madrid, can access a training place anywhere. If I make Madrid have one MIR, Catalonia another and Galicia another, where would a resident prefer to go to train: Badajoz or Madrid? It will end up creating greater inequality that already exists. The attraction of the city will influence and there will be communities that will pay more than others, working conditions will be different, etc. Health should never be a political bargaining chip. Healthcare is not votes, it is people who are sick and who need the best care.
In the long term, the future minister cannot further contribute to fragmenting the care given to the person. A general profile should be chosen. Internists and all general practitioners, such as Primary Care, are the only ones who can guarantee the continuity of care for chronically ill patients with multimorbidity. This person cannot be allowed to pivot from one consultation to another with what all this entails, especially in such dispersed areas with such difficult coverage. There must be a clear commitment from the ministry in general, not to fragment health care, which helps us sustain the National Health System (SNS).
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Juana Carretero has been in favor of “not fragmenting the MIR system or healthcare.”
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