There are 50 specialist doctors missing in the province of Tarragona

Booking a specialist doctor in Tarragona –and in all of Catalonia– is an almost impossible mission. There are not, nor will there be. The job boards are empty. No hands available. And taking into account the number of retirements expected in the coming years, the problem is even worse. Not enough professionals are being trained to cover all these casualties. If urgent measures are not implemented, hospitals and outpatient clinics will be empty of specialists. The problem requires a quick reaction or an urgent rescue plan, since it should be borne in mind that it takes at least ten years to train a doctor, which requires working with some planning.

«Twenty years ago we warned about the lack of doctors. They could have foreseen it then. Now it's too late» Josep Maria Serra, Union Delegate of Metges de Catalunya

In the case of the demarcation of Tarragona, and according to a study by the Col·legi Oficial de Metges de Tarragona (COMT), a total of 50 specialist doctors are missing, distributed among all the health providers in the demarcation. We are talking about hospitals and clinics. So that we understand each other, there are 50 places that are not covered, because there are not enough doctors with the specialty. This is just one example of the situation the health system is going through.

“We have been warning about the lack of doctors for 20 years. Nobody paid attention to us and, now, which is more than evident, the rulers do not know how to solve it. They could have foreseen it then. Now it's too late," says Josep Maria Serra, president of the subsidized hospital sector of the Metges de Catalunya (MC) union.

Serra explains that what is known as the "perfect storm" occurs. Some of the causes that have led us to this situation could be the few MIR positions available in relation to the number of graduates who leave the race, the boom in the retirements of the generation of the baby boom and, finally, the poor working and contractual conditions of this health system, which force doctors to seek a life in other cities or countries.

More than 10 years of training

To understand how we got here, we have to go back to the beginning, to the university. We spoke with the dean of the Faculty of Medicine of the URV, Fàtima Sabench. «Students already spend the entire Baccalaureate pending to get a stratospheric grade to be able to enter the career. Once inside, first they are six years of degree and, later, a year to prepare the MIR – the exam that validates to practice as a Resident Internal Physician. Afterwards, depending on the specialty, they do 4 to 5 years of residency”, explains Sabench. Thus, to train a specialist doctor, it takes at least 10 to 12 years. "This means that the doctors we are training now are not good for plugging the current gaps," says the dean.

"The doctors we are training now are useless to cover the holes that exist today" "Increasing the number of places at the university indiscriminately is a way of covering the mouth of public opinion" Fàtima Sabench, Dean of Medicine at the Universitat Rovira i Virgili

The Generalitat announced a few months ago that one of the solutions would be to increase the number of places in Medicine faculties by 15%. "We believe that increasing the number of places indiscriminately is a way of covering up public opinion, due to the lack of doctors," says Sabench, who adds that this measure has its limitations, such as the lack of space in the laboratories.

For the dean, one of the solutions would be to increase the number of specialist positions. «There are doctors, what there are not are specialists. The Ministry of Health should summon more MIR positions », she adds. This depends directly on the State.

Along the same lines, Manuel Carasol, secretary of the Col·legi Oficial de Metges de Tarragona, believes that "if you increase the number of places in the faculty, but not in the MIR, the funnel effect will be generated". And it is necessary to take into account that in this exam not only students recently graduated from the race are presented. Also non-EU doctors, or those who left the specialty halfway. "What good is it for us to have more graduates in Medicine, and that they cannot specialize?" Carasol wonders.

For the COMT secretary, the important thing is not so much to train more doctors, but to try to ensure that the ones we have do not leave. "And this happens by improving labor and contractual conditions," he explains.

The 'baby boomers' are retiring

According to data provided by the COMT, in the demarcation of Tarragona, last year a total of 81 students finished the MIR. The same year, 82 physicians retired. To this day, it can be seen that, of these 81 residents, only 48 have stayed in Tarragona. The rest have left in search of better opportunities and working conditions.

"If you increase the number of places in the faculty, but not the MIR, the funnel effect will end up being generated" "At this rate, they will tell me how they are going to cover the retirement leave" Manuel Carasol, Secretary of the Official Col·legi de Metges de Tarragona

This year's data shows that 110 residents have been trained, 92 in Camp de Tarragona health centers and 18 in Terres de l'Ebre. Of these 110, 27 have already left. «We have 83 specialists left that have just come out of the oven. We will see how many end up leaving and if the vacancies are filled," explains Manuel Carasol, who adds that in the next five years, from 2023 to 2027, "455 physicians are expected to retire." Carasol assures that, “at this rate they will tell me how the retirement leave will be covered. It's practically impossible."

The explanation for so many sudden retirements is that the entire generation of baby boom –those people born in the 60s and 70s– are reaching the end of their working lives. «30 years ago in the faculties of Medicine there were classes of up to 500 people. There were many of us”, recalls Fàtima Sabench, who adds that “it is a very important number of doctors”.

How to retain staff?

And why is it so difficult to attract and retain specialists in Tarragona hospitals and outpatient clinics? One of the reasons is, without a doubt, that 70% of the students of the Faculty of Medicine of the URV are from outside Catalonia. Mainly from Valencia, Castelló and Alacant. This has to do with the existence of the single university district, which allows any state student to apply for a place at any faculty in the country, under equal conditions. Catalonia is the community that offers the most public places.

The problem is that these students, upon finishing their training and residence, return to their city of origin. They are students without roots, young and without ties. «If they are not offered good conditions, they leave. We spend time and money training them so that they end up working here," explains Sabench.

For his part, Manuel Carasol, from COMT, assures that "the key would be to make the squares in Tarragona more attractive", for example, improving the contractual relations of doctors, respecting family conciliation, equalizing salaries to other European countries and with the possibility of further training.

The fear is now with the arrival of the two private hospitals announced in Tarragona city. “This will further aggravate the situation. To the minimum that they offer better conditions to the doctors, these will end up leaving the public. And it is normal, each one looks out for him”, explains the union delegate of Metges de Catalunya, Josep Maria Serra. The threat of the flight of professionals in the coming years worries the sector and the administrations.

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