With the resurgence of the demand for a Faculty of Medicine for the University of León, which has the scarcity of professionals as a backdrop, it is convenient to analyze the current situation of the health system in the province. The president of the León Medical Association, José Luis Díaz Villarig, defends that the measures must be guided by professional and not political criteria.
– The University of León has once once more demanded a Faculty of Medicine to deal with the shortage of professionals. What is the position of the College of Physicians in this regard?
– I have already manifested many times and some of them a long time ago. At least 15 years ago, when the counselor was Guisasola. At that time, there was the particularity that the Board decided to increase the number of students in the medical schools in the community. The deans came out to say that this would affect the quality of the training and that is why we already asked that a faculty be created in León. That did not work and now it has resurfaced once more.
– Is it resurgent now because it is more necessary than ever?
– Not necessarily. A Faculty of Medicine has economic and social components for the city in which it is installed. Of course it would have been interesting if there had been a Faculty of Medicine in León for many years. Right now there are medical schools everywhere. Almería has a Faculty of Medicine and here it seems that we are thinking regarding it… It doesn’t make much sense.
– What measures does the College of Physicians propose to deal with this shortage of professionals and future retirements?
– The number of doctors in Spain right now is higher than it was a few years ago. Whether it is sufficient or insufficient depends on the provinces and many factors. It cannot be said that doctors are lacking in general, because in many cases what is lacking are certain specialties, mainly Primary Care, because the replacement rate is not the same in all specialties. Family Medicine has less than one, and in others six new doctors appear for each one who retires. It is a complex issue that requires that everyone who has to do with it contribute their opinion and reach a consensus, what happens is that at this moment the opposite is happening: they do not take into account those of us who know regarding the subject, we are the professional associations, and we see a confrontation between political parties that, in many cases, say one thing where they govern and the opposite where they do not govern. Therefore, in the end, the house to be swept.
– Sacyl’s loyalty plan has not had the expected effect. How might it be improved?
– The problem in Castilla y León is not uniform either, it is not even within the province of León. Loyalty doctors in Valladolid, Salamanca or León is relatively simple, but it is very difficult in many other places, and in particular in El Bierzo. Most of those who study medicine or do their specialty here are not from Castilla y León, so when they finish they want to go back to their homeland.
– Are you surprised by the silence that the unions are maintaining in the face of the lack of professionals that we often learn regarding from patient complaints almost by chance?
– No. I repeat that it depends on the territory. For example, León is a discriminated province in terms of the number of doctors compared to Valladolid. The number of doctors that León has for every 100,000 inhabitants is lower than that of Valladolid or Salamanca. We are not okay. And the case of Bierzo may be the worst health area in Spain. If measures are not taken immediately we will have very serious problems.
– But what I was asking you: Are you surprised by the silence of the unions in the face of the lack of professionals that we often meet through patient complaints almost by chance?
– There is an organization called CESM and that I chair that has shown itself to be vindictive on this issue. Other class organizations represent more workers, not just doctors, and the messages are diluted. We have experienced a difficult situation due to the pandemic to make demands, but I think that the union organizations are all on the same line.
– This week the medical director of the Hospital del Bierzo, José María Pelayo, resigned, saying that to dedicate himself more to training: do you consider that this resignation has to do with the chaotic situation in the center?
– He was already leaving and has been for a while because he wanted to help the situation that El Bierzo has, but it has nothing to do with the problem, although I suppose it also weighs. It is very difficult in this circumstance to be the medical director of the Hospital del Bierzo, but these problems have nothing to do with the director on duty being better, worse or regular, but with the wickerwork that is there, it is very difficult to make baskets. We have been saying it for years and no action has been taken, drastic measures. An attempt was made to make an area of difficult coverage, but that failed and has continued to worsen the situation. Although the places come out, the professionals reject them.
– In the Cortes, UPL and PSOE have requested the dismissal of the manager as the source of the problem in the hospital. Do you consider this to be the solution or the beginning of it?
– The approach they have made is one of absolute ignorance of the situation in El Bierzo. They don’t know what they’re talking regarding. I wish the problem was the person who runs the health system in El Bierzo, but a lot of managers have passed by and the situation has not stopped getting worse. Of course, it is not a problem of a person, nor of some people, nor of a direction. A significant number of doctors are missing and this has to be solved immediately. At the time that there are more professionals, that we are in the ratios no longer of more developed areas but of bordering provinces, then the magnifying glass might already be put on the management, but in this way, without means, if where they had to stand guard 7 or 8 people there are 2 or 3, blaming the manager is not knowing the problem.
– The Platform in Defense of Public Health in Bierzo and Laciana is preparing a new mobilization and its president, Pilar Carrasco, recently lamented that in the previous ones the participation of the group of professionals had been lacking…
– I said years ago that at the forefront of any mobilization of the groups that work in the health system and of the citizens, the College of Physicians, which is an apolitical organization that has the right to defend the citizens and that it would not have any problem in put myself at the forefront of those protests. I have seen several councilors go by and I see this one that he is going to try with all his might, that he is going to find a solution. They say they are tired of lies and in reality we are all tired of the problem persisting. Now there is a competition in operation, from the perspectives it seems that the places are not going to be filled, but in a month or month and a half the counselor has to take the necessary measures to find solutions.
I wish the problem was the person who directs the health system in El Bierzo, but many have happened and this has not stopped getting worse– Where would these measures go? Economic incentives?
– I firmly believe that it is not only a question of money. Professionals who are not from here prefer other destinations for various social, cultural and also economic reasons, but I do not insist that it is not only a question of money. It has been offered that doctors from other provinces go voluntarily and the answer is awaited. The situation is complex, but they govern them because they want to, nobody has asked them to, so if they cannot provide solutions, the best thing is for them to leave. We need immediate and long-term measures. As I have said, it is not only a question of professional ambitions, but in order to make the decision to go there to live, if you are from abroad and have the choice, many other attractions must be offered, not only to doctors but to other types of professionals. It is something that these platforms do not enter and I think they should. Now there is an important offer for the medical community, not only here but everywhere, so we have to make our offer more attractive.
– Sacyl has recently announced the implementation of a plan so that patients can choose a specialist from hospitals throughout the community. Do you see it feasible?
– It is positive, but also difficult. It is the ideal, but in reality, and we will see it in the near future, it has a utopian component. I can choose where I am attended to, but it is utopian to think that I want a specific person to attend to me. It has a utopian component even in private medicine.
– What is your opinion of the plan to reduce surgical waiting lists by carrying out operations in the followingnoon?
– The first thing to do is to take advantage of all the means that the health system has in the morning. The working day decree says that the doctor’s work is from 8 to 15 hours, but in some cases, those who entered following 2012, are working four mornings and one followingnoon. This measure is voluntary and is not enough to end waiting lists, which continue to be a scourge for citizens. It’s not possible. Measures must be taken, whatever they may be, because the citizen does not deserve to be waiting. The only undoubted good that the human being has is health. The rest, if he loses his health, is worth nothing.
– Is the telephone modality in consultations with Primary Care doctors here to stay?
– The doctor-patient relationship is personal, it is not through a plasma. We are seeing many problems for doing it telematically. It may be interesting among professionals, but if we want to take it to a non-face-to-face event, we are doing the patient a disservice. Years ago we tried to have the doctor-patient relationship declared a World Heritage Site, because there are many diseases with a psychosomatic component. Before, there was a close relationship between the doctor and the patient, and that is undoubtedly positive, because empathy has a lot to say in the medical act. Unfortunately, the previous council wanted to develop this topic of the telephone consultation and for us it is outrageous.
– For years there has been talk of a Primary Care reform that has not yet arrived. Is it starting to get urgent?
– Primary Care must be reformed. We have two systems, the office system from over a century ago and the health center system, which appeared in the 1980s. In this community the two systems have been coexisting during these years. Castilla y León has 3,600 clinics, probably more than the rest of Spain. The doctors spend part of the morning on the road and with their car, so it doesn’t seem the best. It has to be reorganized and with the union of all the organizations, all the parties and all the citizens we have to create a viable system, because that will benefit everyone.
