The call for Internal Resident Physician (MIR) positions for centers in the province this 2022 exceeds, for the second consecutive year, fifty positions in the specialty of Family and Community Medicine. More than fifty doctors will join nearly thirty health facilities in Tarragona this year to begin to shore up the replacement in one of the areas with a higher rate of professionals over 60 years of age: in Catalonia, a third of them are close to retiring. But, are the 52 positions offered enough to hold the primary?
“A boat soon, it is likely that there will be few”, values the dean of the Faculty of Medicine of the Rovira i Virgili University (URV) in Reus, Antoni Castro, who recalls that “in general, in the entire medical community, if we consult the age pyramid of practicing doctors we see that, in the next five years, there will be an increase in retirement and a replacement will have to be made».
“Despite allowing more doctors to enter the MIR program, it is important to bear in mind that the training lasts four years and that is how long it will take for them to hit the streets, so you have to be a bit farsighted and we are already late », adds Castro, who emphasizes that all doctors «are registered and our data, age, specialty, where and what we work for, when we will retire… so it should be easy to plan needs in 5, 10, 15 or 20 years”.
“In Catalonia we are a little higher in the ratio of family doctors but, in terms of age, 20% are over 60 and 42.4% are over 50,” he adds, and indicates that ” There is no doubt that increasing the number of MIR positions in Family Medicine is opportune and is really very positive”, although “as to whether the intensity of this increase is the right one, I think that perhaps we are falling short. In any case, they are objective data and it is not a matter of opinion: it is possible to know exactly how many doctors are going to retire and thus see how many are going to be needed to maintain the same volume as now».
The last MIR exam was held at the end of January and the graduates who obtained an order number have been facing the choice of their destination since last week. The dean of Medicine insists that “the MIR is not used to assess whether doctors are good, it is not its function, it is an exam that is done on a specific day when one may or may not be inspired, which lasts for certain hours, and number 1 does not necessarily have to be the best doctor» but rather «he simply orders them and, if there are 8,000 places, it does not mean that the one who stays in 8,001 is not prepared». “We are talking about a group that enters the faculty with a 12 or 12.5 in the selectivity and that will have finished the race”, he specifies.
In this sense, although lately this has not been the case, “it happened in previous years that there were fewer positions than doctors who were trained, and that generated an accumulation of between 400 and 500 each year who did not have a MIR position”. Now – in 2022 there are 8,188 positions in Spain, about 200 more than in 2021 – “let’s say that all the students who finish the degree could access it, but there is a competitor who is the student who comes from outside and who also occupies it”.
The needs of the population
The number of places “had not been adapted to the needs of the population and, over time, the analysis of whether we needed more or fewer cardiologists, more or fewer gynecologists, had not been adjusted, it was invariable, but recently it seems that it has they have put to it and it is discovered, for example, this precisely: more family doctors are needed, and there is movement».
And the scenario in which a family doctor works, is it attractive for graduates? Castro specifies that “this has been analyzed in the Fòrum de Diàleg Professional and it was considered convenient to incorporate new groups into the basic areas to favor the distribution of tasks, reducing the pressure on the doctor and allowing him to better perform the function for that has been prepared.” In this aspect “it is possible that there is room for improvement” and “the scientific society, the Catalan Society of Family and Community Medicine and the health institutions are the ones who have to carry out this study and make decisions if they consider it so », also with the aim that «the patient is always better cared for». Family Medicine is present at the university and a special interest has been placed on it.
A few days ago, the president of the Official College of Metges of Tarragona, Sergi Boada, pointed out to this newspaper that “the capital figure of the primary care professional must be recovered, since there is a biased perception of these specialists” and he also specified that “despite the fact that it is the specialty with the greatest offer of places, it still continues to be one of those assigned in the latest MIR numbers”.
“It is necessary to empower the doctor,” he added, after claiming positive discrimination actions in the remuneration conditions for Family MIRs, some of which the Government has undertaken.
In the Faculty of Medicine of the URVen there are about 125 students each course and, as the training progresses, some of them are lost. Castro details that “70% of our students are from outside Catalonia because it is a unique district. Above all from the Valencian Country but also from Madrid, Extremadura, the Canary Islands, Galicia… everywhere, and more from Alicante than from Barcelona».
A small part of those who start in Reus end up disassociating themselves from the URV because they drop out, but “others do their best to get closer to home for whatever reason, although it is usually linked to the economic crisis: training abroad costs money and many families suffer.” Therefore, those that culminate are usually between 100 and 110.
Linked to this, the dean specifies that “if the reasoning is made that, since we want more doctors in Catalonia, we should increase the places in the universities here, we must be careful because perhaps that will not ensure that they remain to practice here but that the majority, when they have the MIR, will probably return to their origin». “I’m not saying that this is a good or bad thing, but simply that those who plan should keep it in mind,” he specifies, “because here we will also train doctors who will practice throughout the State.”
Shorten deadlines and incorporate earlier
On the other hand, “students spend six years studying Medicine, in recent years they do a lot of clinical practice and the sixth is an exclusively practical course, without theoretical subjects, almost like a first year of residency.” At the end of the degree, «after all this learning continuum, seeing patients and knowing everything they come to know, one month of May, they will sit in a chair to study for an exam called MIR and that the only thing that it intends is to order them, that it does not seek to know if they are capable or not because we have already decided that previously at the university».
With this system, “they will not enter as first-year residents until eleven months after finishing their degree” and these are “eleven months that go by without seeing a single patient, without doing any practice, without discussing anything with any doctor or with no colleague or anything, just sitting down preparing an exam that will create order,” explains Castro, who says that “in 2021 we had more than 7,200 doctors who could practice as a year of residency but who will do so in eleven months.”
“If you want to have more doctors and it is necessary, move it forward, do not do the exam in January, do it perhaps in October and that may mean another way to incorporate them before”, he proposes, although he clarifies that a variation of these characteristics “ it could also end up overloading the teaching units, since two batches of residents would coincide».