There is a growing call within the healthcare system for a reformation of medical training at universities and for a mandatory four-year residency period following graduation. Currently, recent graduates can choose whether or not to pursue residency programs, as the university degree allows them to practice medicine immediately upon registration.
A recent analysis of residency applications for a major university hospital revealed a declining interest in critical specialties like internal medicine, intensive care, and pediatrics. “These core specialties are crucial for patient care and serve as a foundation for other specialties, yet these professionals remain the least compensated despite heavy workloads,” explained Pablo Young, director of the Department of Teaching and Research at the British Hospital of Buenos Aires.
New graduates are opting for higher-paying specialties such as anesthesiology, general surgery, dermatology, orthopedics and traumatology, cardiology, ophthalmology, diagnostic imaging, and otorhinolaryngology, according to a survey conducted by the Británico team.
“This analysis highlights the need for reform in the medical training system, including initiatives like making residencies mandatory, reducing university training time, and eliminating multiple jobs,” stated Young. Previously, various stakeholders in the healthcare system, including professionals, academics, and even the Ministry of Health, had already advocated for revising the scope of residencies.
Intensive care, a critical specialty with few candidates – Credits: @Rodrigo Néspolo
This university hospital, associated with the University of Buenos Aires (UBA), conducts its own residency selection process separate from the Single Exam, a national evaluation which was held last Tuesday and had over 8,200 eligible applicants, As reported by LA NACION .
Young’s team analyzed the demand for residency positions at the British Academy, which are highly sought following. Applicants who also took the national exam often register for three different contests, according to interviews with this newspaper.
Data from the selection process to fill 67 residency positions offered at the British University for basic and post-basic specialties shows that 1,386 graduates from health professions registered, with 48% being foreign nationals, a proportion higher than the 31.1% estimated by this medium for the Single Examination This increasing percentage of foreign applicants is worrisome across specialties, as it indicates a decline in the number of Argentine professionals entering these fields. For instance, in intensive care, 80% of applicants are from other countries.
Of the total number of applicants, 1,295 took the exam to fill 55 positions in 12 basic medical specialties and seven non-medical specialties, such as nursing, biochemistry, or kinesiology. The remaining 91 candidates competed in two interview rounds for 12 positions in post-basic specialties.
The analysis revealed a “decline in interest in critical specialties such as internal medicine, pediatrics, and intensive care, which are essential but less remunerated compared to other specialties,” the researchers explained. Conversely, there was an increase in the number of applicants for residencies in specialties like anesthesiology, cardiology, general surgery, dermatology, diagnostic imaging, ophthalmology, otorhinolaryngology, and traumatology, as these are more economically valued fields.
Pablo Young, director of the Department of Teaching and Research at the British Hospital in Buenos Aires
“The devaluation of the doctor’s role jeopardizes the training of specialists capable of handling the increasing complexity of patient care,” emphasized Young. He believes that part of the solution lies in modernizing the medical curriculum and degree duration, making residency mandatory, and eliminating factors that contribute to multiple jobs, limited rest, and insufficient compensation.
“While the pandemic highlighted the value of healthcare personnel, it also revealed the existing crisis. Fewer high school students are choosing to study medicine, while the demand for doctors is increasing,” Young continued.
Marcelo García Diéguez, associate professor of Clinical and Epidemiological Analysis of Health Determinants at the Department of Sciences at the National University of the South, has argued that there is a critical debate to be had in the country regarding the autonomy granted by university degrees and the need to make residency mandatory for professional practice.
The Ministry of Health of the Nation also recognizes this need: “Residency is the most crucial health issue for the next decade. We all agree on that, and we are working on training pathways: the faculty, the residency, and optimal equipment for patient care,” stated the national health portfolio.
The Argentine Forum of Public Medical Schools and Faculties of the Argentine Republic (Fafemp) has been striving since last year to propose changes to residency regulations in order to improve training conditions.
Young stressed the urgent need to address the healthcare human resource crisis, including the sustained drain of trained Argentine professionals to other countries, a serious problem that has not yet been resolved. “The issue will become more critical when there are no longer enough doctors with deeply specialized clinical training to handle the increasing complexity of patient care, both outpatient and inpatient,” Young warned.
Last week, more than 8,200 applicants took the Single Examination for medical residencies throughout the country; in the photo, the venue at the Olympic Village – Credits: @Ricardo Pristupluk
“Medical residencies, a fundamental foundation for professional training, require a shift in their paradigms, demanding a collaborative effort between training institutions and entities that provide healthcare human resources. Maintaining the high quality of residency programs is quite a challenge,” Young stated in an interview with LA NACION.
He highlighted that a persistent issue in his 18 years of experience in the teaching field is the tendency of doctors who complete residencies to choose specialties that are not a priority for the country’s health needs.
“Currently, there is a shortage of general practitioners, family doctors, clinicians, therapists, pediatricians, psychiatrists, and epidemiologists, among other specialists necessary to care for the health of our population,” Young added. “We are transitioning from a hospital-centered paradigm to a primary care-oriented approach, implying that a person receiving treatment in a primary care center should find personnel trained to properly manage their case and refer them to hospitals or more specialized centers when necessary.”
He believes that the operation of these interconnected centers should be “better coordinated.” To achieve this, he asserts, more professionals are needed in specialties that focus on prevention and health promotion. He also emphasized that “the country needs more general practitioners, family doctors, and clinicians with a strong primary care orientation,” as it is in primary care centers (previously known as “little rooms” in the neighborhood) where up to 80% of health problems addressed in hospital emergency rooms might potentially be resolved.
“We need to seek professionals who are committed to the role of community medicine,” Young concluded.
Argentina’s Medical Training Crisis: A Call for Reform
The healthcare system in Argentina is facing a growing crisis, and at the heart of the issue lies a shortage of medical professionals, especially in critical specialties. This shortage stems from several factors, including a devalued role of doctors, insufficient pay, and a lack of interest among recent graduates in pursuing certain essential specialties.
A Disconnect Between Demand and Supply
A recent survey conducted by the British Hospital of Buenos Aires unveiled a troubling trend: a decline in interest among medical graduates in specialties considered crucial to the health system, such as internal medicine, intensive care, and pediatrics. This decline is directly related to the perceived low financial rewards associated with these specialties, especially when compared with more lucrative options like anesthesiology, general surgery, dermatology, orthopedics and traumatology, cardiology, ophthalmology, diagnostic imaging, and otorhinolaryngology.
The problem extends beyond Argentina’s borders. The country is experiencing a significant “brain drain,” with experienced medical professionals opting to work abroad due to the better working conditions and compensation they find in other countries. This further exacerbates the existing shortage of doctors, particularly in critical specialties.
A Call for Reform
Experts and stakeholders within the health system are increasingly advocating for a comprehensive reform of the medical training system in Argentina. Key proposals include:
- Making Residencies Mandatory: A central recommendation is to transform residencies from an optional stage to a mandatory requirement for professional practice. This would ensure that all graduating doctors receive the necessary supervised training before entering the workforce.
- Reducing University Training Duration: A shorter duration for the medical degree program might allow students to enter the workforce more quickly. This reduction, however, needs careful consideration to ensure that the core curriculum is adequately covered and that students acquire essential clinical skills.
- Eliminating Multiple Jobs: The current system often forces doctors to take on multiple jobs to sustain an income that aligns with their responsibilities and the demands of their profession. Eliminating this need would improve doctors’ well-being, reduce burnout, and enhance patient care.
- Modernizing Curriculum and Training: Adapting the medical curriculum to reflect the evolving needs of the healthcare system is crucial. This includes incorporating modern practices, incorporating preventive care, and emphasizing the importance of primary care.
The Importance of Primary Care
While the focus has often been on hospital-based specialties, increasing attention is being placed on the importance of primary care. This shift in focus is crucial for promoting early detection, preventative measures, and managing chronic conditions, ultimately leading to better health outcomes for the population.
Experts emphasize the need for greater investment in primary care centers and the training of professionals in specialties that directly address community health needs, such as family medicine, general practice, and public health.
In the meantime, the current situation demands urgent action to address the shortage of medical professionals, particularly in critical specialties, and to create a more sustainable and supportive environment for medical practitioners in Argentina.
A Future in Jeopardy
The long-term consequences of neglecting this crisis are significant. If left unaddressed, the shortage of doctors, coupled with the “brain drain,” will only worsen, potentially leading to:
- Reduced Access to Healthcare: Longer wait times for appointments and procedures, limiting people’s access to quality care.
- Increased Burden on Hospitals: Primary care centers become overwhelmed by cases that might be managed in less complex settings, leaving hospitals with higher patient loads and fewer resources.
- Compromised Quality of Care: With fewer specialists available, and often overworked, the quality of patient care may decline.
- Financial Strain on the Healthcare System: The increasing burden on the system will likely lead to higher healthcare costs and further strain on already limited resources.
A Collaborative Path Forward
Reforming the medical training system in Argentina requires a collaborative effort. Universities, hospitals, regulatory bodies, and government agencies all play vital roles. A concerted and proactive approach is essential to create a more sustainable and effective healthcare system that can meet the needs of the population.
This challenge is not insurmountable. By investing in medical education, creating supportive working conditions for physicians, and promoting a greater emphasis on primary care, Argentina can ensure that its citizens have access to the high-quality healthcare they deserve.
