Ernesto santos, Interventional Radiologist at the Memorial Sloan Kettering Cancer Center, New York Born in Segovia and closely related to the towns of Quail Y El Espinar; Ten years ago Ernesto Santos, Interventional Radiologist, who worked at the San Carlos Clinical Hospital in Madrid, decided together with his wife that putting land or sea in between would be good for his professional career and the education of his daughters. The change was one of residence, work, culture … and the consequence, the need to adapt to “what is there” … How is the world that was found, the differences when working in medicine in a country and in another and, of many other details, he himself tells it …
Question.- When you came to the U.S?
Reply.- I worked in Madrid, at the San Carlos Clinical Hospital and, mainly, I carried what we currently call Interventional Radiology. Towards 2009, as both personal and professional motivation, my wife and I thought that “as we had two daughters, it would be good to give them a different culture and learn English … and on the other hand, in our case, to seek a professional opportunity in the USA.”
I sent emails, without having contacts there and I received a response from a couple of them and, as an anecdote, I tell you that my wife and I looked at the map. One was from Pittsburgh and another was from Kentucky. I came to Pittsburgh. In 2010, at Christmas, we presented ourselves here. I was here 6 years, and I was improving my professional capacity.
I better understood the “market American ”of health, the academic world and… after six years in that city the size of Zaragoza, with a good quality of life that served very well to raise the girls … as my daughter Lucía had to start her studies at the College, my wife and I spoke again.
It was convenient to look for another place, a larger city, better connected with Spain through flights and that was close to Washington, which was the place where our daughter was going to be … There was an opportunity in New York, in the center that I work now, one of the most important in relation to cancer in the US, the Memorial Sloan Kettering Cancer Center, and we moved here in 2016. It has been four years now.
P.— Adventure …
R.— Yes, I moved without contacts. Once I was in the American market I got to know more people: The Pittsburgh experience, my publications. All of this helped me to get hired at the Memorial, in New York. I worked really hard when I got to Pittsburgh. The first 2 or 3 years, the language It made me take longer than the rest, but the merits they work very well.
P.— Is there much difference in the way the Health Sector works and how it works in Spain and in the US?
R.— For me, there were things that cost me more and others less. In Spain, the Public System is 7 or 8% of the Gross Domestic Product (START) but, in the US it is 18-19%, which means that there is a lot of money in the system. When I came here, the least difficult thing for me was to “make patients” because it is the same as in Spain: You see it, you do the interventions, but, “everything that surrounds seeing the patient …”
In the United States there is a lot of regulation that obliges doctors to have administrative knowledge that in other places “almost does not exist” and together with this knowledge, billing or billing, which involves “mastering what is invoice to patients ”, something that does not happen in Spain.
This system requires a great deal of administrative effort. When I make my reports here, every detail is linked to a code that is ultimately computed so that the patient pays … Everything is a negotiation between the insurers and the Hospital. Of all that you have to learn, what has cost me the most has been that administrative part of the system. The quality standard of healthcare is good, but what insurance companies charge patients is sometimes… abusive.
It has become a system that, as the numbers say, if the Gross Domestic Product (START) in Spain it is 7 or 8% and in the USA it is 19%, it means that 19% of the salary is used by people in medical insurance or in something related to health.
P.— In short, in Hospitals you have to look a lot at what the money.
R.— I have only worked in the academic environment, not in the private sector but in the academic environment, although they say it is non-profit, it is not true. These academic institutions make a lot of money, although they have the label that they do not. Therefore, it is a system in which the economy is much more present, it is not like the public system in Spain, not even like the private one. The quality is high but, every day there is a new rule.
P.— American healthcare has a reputation for being… business.
R.— There’s a little bit of everything. From personal experience, people who come from Europe or have experience in public centers, we treat patients better by having this training in other countries. In the USA, doctors have been educated, too much on the pecuniary part and less on the human part but, there is everything as in all places.
P.— Do you miss working on this side of the pond?
R.— I’ve been here for ten years and, like everything else, you miss some things, others don’t. Everything has its advantage and its drawbacks. It is true that I would like to take care less of the administrative parts: Neither the patient nor I should be occupied by how much a procedure costs, creating a conflict ethical or moral since there are times that invoice things that some people cannot pay and this fact makes those people excluded when receiving certain treatments but, you have to work and adapt to the system in which you are working. What you can’t do is fight him.
Each one does, within their culture, what they can. Although it is true that, as we said before, the practice of medicine in the USA is less humanIt is also true that it has very good things: The “Meritocracy” and medical training, which is much more regulated and regulated than in Spain and, when doctors leave the School of Medicine, the standard is quite good, very good.
P.— Is the tremendous specialization of the doctors there true?
R.— Yes. And more and more. As an example I will tell you my case, in which the two extremes are seen. At the San Carlos Clinic we were 4 Interventionists who “did everything”. Now they continue like this … In New York, at the Memorial, where I now work, we are 25 doctors in my unit, just working in Oncology. Furthermore, I am super specialized in what we call “Bone and Lymphatic Interventions”… Yes, they are very specialized, for the good and for the bad. For the good because people “refine a lot” in what they do very well and, for the bad, is that sometimes they lose the perspective general and don’t put the camera a little further back to see the whole world …
P.— Have you considered the return?
R.— I have discussed it with my wife on several occasions because the initial idea was to come here for three years but, when I arrived, I was embarked on a four-year plan called “The alternative way” that is aimed at doctors who come from abroad. . Through it, they get the American accreditations. I thought we would be there for three years, in that time I would acquire cultural and professional experience and, we would return to Spain but you know, the children are here, they live well, their studies are going well, we were comfortable in Pittsburgh and, we left it for a year and other. In the end, I took the American exams and I have all the certifications. Now, return It would cost me because I don’t know if there is a place where I could work in the same way that I do today in New York. Working in surgery is more common but in interventionism, in what I do, there are very few people specialized in it in Spain.
As the years go by, it is more complicated turn around. I couldn’t make plans now because one of my daughters is working in Washington, although, in two years, she could be elsewhere. My daughters would not be surprised if Belén (my wife) and I returned to Spain, they are independent. What I could not do is ask them to all return, my little daughter starts university in the USA this year.
What I would recommend is that they do a postgraduate or something like that, some kind of training, in Europe. Although we have taken care that every summer they see the family and have the feeling that they are Spanish, the more time they spend here, the more difficult they do not lose that connection.
For my part, I i will retire in this country. I will retire in Spain, if I don’t go before.
P.— Coming to the end, we cannot forget that in these times the USA is experiencing a special moment for the elections. Although the result is known, everything is in the air …
R.— You have to understand this country. It is bipartisanIt is not very polarized … except for the last few years until reaching the highest point, which is what we are experiencing now.
To sum up, a politician like Biden, career, with 40 years in public institutions, is fighting against the typical NY businessman who knew all the tricks to make money and became President.
You have to understand the system of elections in this country, here you vote person. Trump ran for the Republicans because he had an affinity with them but, among the curious things that happen in this country, is that people vote for candidates like that.
Other choices that we have lived here have been calmer. The Democrats would be the Center-Right in Spain, the left does not exist here although the Democratic Party is so large that within it there are groups that could be close to the Socialist Party of Spain but the most extreme part of the party would never reach the Presidency. For that, it takes a 20, 30, or 40-year transition in this country, and that’s why the Democrats chose a more focused candidate so that he could win.
The Republicans…. I do not know what to tell you. It is such a heterogeneous party that it can have a candidate like Trump, a person who has not been a career politician and who has only managed things. If you see the map of how the votes are distributed, the coasts vote Democratic and, anything that is in the center of the USA, that is not a city, votes Republican.
These elections have been lived with more intensity than ever because a politician like Trump, a shark from New York, has participated, who can appear on television telling a lie and… It doesn’t matter! Very authoritarian, it seems that more than governing, he is running your company, managing the country “via twitter”
P.— According to you, would it be possible for Trump to appear in any other country in Europe?
R.— Yes I would see it for him populist movement there has been.
Trump is a outsider, a populist who has moved a great disgruntled mass of traditional politicians who are in Spain and in other European countries. The reason has been discontent with traditional forces that have failed to maintain a good standard for the population. That discontent, very marked, has led to other parties such as Vox Y We can, which did not exist 5 or 6 years ago.
Trump is a unique character in politics. What’s going to happen? It is not known why Trump is forcing another count In some states, the differences are going to be, I don’t know if it will reach a hundred thousand votes. Hopefully Joe Biden comes out
P.— To finish, how do people, your colleagues, take it there, do you talk a lot about this?
R.— There are two things you learn when you come to the USA: There is no talk of religion or politics, but Americans do not vote for the social content of a program … “They vote for the pocket.”