Could Primary Care Disappear?

“In a few years Primary Care medicine will have disappeared”. It is the complaint that he makes from the Seville Medical Unionon president, Raphael Ojedaaccording to the data collected by Dr. Vincent Matasfrom the Medical Union of Granada, in an exhaustive study on the future of staff of family doctors and pediatricians in Primary Care.

According to him, currently “around 20% of family doctors are missing” in Primary Care. Between 2021 and 2026, it is intuited that the number of professionals “will have decreased by 30.8% in Spain and 28.2% in Andalusia”. “An increase in the deficit that means that in the next four years the templates will have been reduced by half“, Andalusian doctors warn. This situation, “It will make it impossible to provide medical assistance in Primary Care”Ojeda sentence.

The study by Dr. Matas points out that, if the expected number of family doctors is formed between 2026 and 2036, in that decade the deficit of these specialists could be alleviated. However, “it is impossible for Primary Care medicine to survive for 15 years with a workforce reduction of these dimensions”.

Progressive aging of the templates

In this sense, doctors warn of the progressive aging of Family doctors, of whom 53% are over 50 years old and 27% are over 60. However, as revealed by the Supply-Need Report for Medical Specialists 2021-2035, by Patricia Barber Pérez and Beatriz González López-Valcárcel, these figures are similar in public health as a whole, where 46% of doctors have more than 50 years and 21.1% over 60. The retirement of an important part of the medical staff will affect the whole of Spanish public health in the next 15-20 years, although it will happen first in Primary Care. According to this report, most of the specialties will suffer a relative shortage of physicians in the immediate future, as shown in the following table that we take from it.

With these data, from the Medical Union they conclude that the deficit of specialists “will be especially pronounced in the next 10 years”, given that the increase in graduates in Medicine and MIR places that has already begun will not result in an increase in specialists until that period of time has elapsed.

“In these circumstances, if the serious precarious situation that family medicine suffers in Primary Care persists, a significant percentage of the positions in this specialty will remain uncovered, given that the newly graduated doctor will opt for specialties with better working conditions. If so, the expected reduction in Primary Care family medicine staff for the next five years could be much higher than 50%. Factors such as the growth of the private medicine o to departure of doctors abroad”, Ojeda apostille.

Pediatrics does not escape this trend

“The case of pediatrics shows the plausibility of our hypothesis,” says the president of the Seville Medical Union. According to the report of doctor Matas, in Spain, 53% of Primary Care pediatricians are over 50 years old and 23% are over 60. “In Andalusia it is even worse: 61% are over 50 and 27% over 60,” says Ojeda. “However, the figures change radically in hospital paediatrics, where only 28% of Spanish paediatricians are over 50 years old and 11% are over 60. In Andalusian hospitals the figures are similar, with 29% older over 50 and 11% over 60. It is evident that young pediatricians massively opt for hospital practice of his specialty. In fact, the serious deficit of pediatricians that Primary Care suffers does not exist in public hospitals or in private medicine, although the situation in these areas is far from ideal”, he adds.

For Andalusian doctors, the management of Spanish public health “has been based for years on the existence of a plethora of unemployed doctors”, which “forced them to accept any type of contract and work environment, no matter how precarious it was”. “Absence of incentives, high temporary employment rates and low wages were outstanding features of this model. The doctor must be satisfied by the mere fact of having a job. Many managers continue to think like this and the system is incapable of attracting and retaining doctors, because it is based on coercion and contempt. In fact, in areas such as Primary Care, working conditions continue to worsen, a suicidal tendency in the current circumstances”, he argues, alluding to the fact that “the recurring mantra that there are no family doctors is nothing more than a excuse of our politicians to hide their responsibility for the collapse of Primary Care”.

“The deficit of specialists should not be greater in Primary Care than in Hospitals. If it is, it is due to the fact that the growing underfunding of this area of ​​health, together with a constant increase in the health offer to the population, has caused an unbearable work overload and a serious deterioration in the working conditions of doctors. Not one of the measures adopted in recent years has been designed to alleviate the shortage of doctors. If this trend does not change, Primary Care medicine will disappear within a decade”, forcefully stated the president of the Seville Medical Union. “Our managers remain impassive before the disaster that looms, a disaster that doctors cannot stop alone. At least no one will be able to reproach us for not giving notice,” he concludes.

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