The health system is in crisis. Not only due to lack of budget or resources. There are fewer and fewer doctors. And that is a serious problem for the future. There are specialists who warn that if this is not reversed in time there will not be enough staff to care for patients. “It is very serious. We are running out of doctors,” warns Roberto Freue, head of the Lanari Institute’s Medical Clinic Service.
The pillar that supports a large part of the system are the residents in the clinical specialties. They are the ones in charge of answering 90% of the queries. The problem is that there are less and less. This happens in public hospitals where residency vacancies are not filled. The most affected specialties are pediatrics and clinics, key in the operation of any health institution.
Lack of pediatricians
Pediatrics is one of the hardest hit specialties. As he was able to find out Clarion, very few graduates of the Faculty of Medicine of the University of Buenos Aires (UBA) choose it as a career. “There is little interest in clinical residencies. It is a trend that has been increasing every year. In many public hospitals, there is an increase in surplus residency vacancies, which are not filled,” says Pablo Moreno, president of the Argentine Society of Pediatrics (SAP).
According to this entity, in the last year 20% of the residence vacancies remained unfilled in the City of Buenos Aires. “This is a danger. Because it is the residents who often bear the workload of public hospitals,” says Moreno.
Sources from the Argerich Hospital explain that “there is a re-adjudication instance that is the last opportunity for that position to be filled. If it is not filled, the position remains vacant during the 4 years of residence. In other words, they are left without an R1, the following year they lack an R2, and so on until the 4 years that the residency lasts have passed.
Due to this trend, the SAP has been sending notes to the Ministry of Health of the Nation to alert about this problem. There, the entity “expresses its concern about unfilled vacancies, especially in the public sphere, of Pediatric Residences, according to the survey carried out by the presidents of the nine regions of the Society.” The note highlights the impact that this situation will have on the training of new paediatricians.
Demotivation
Moreno explained some of the causes behind this phenomenon. “There is little interest in clinical residencies. It is a trend that is increasing every year. There is a new generation of young doctors who are not willing to work long hours for little money. It is a serious public health problem in the future. In five or ten years it will be a very difficult scenario.”
And he listed that moonlighting, low professional salaries and the high level of stress are the main reasons for this decrease in residents in these specialties. “All of this will have an impact on people’s care, on the quality of care in the future,” added the pediatrician.
No pediatricians in La Plata
A clear example of what is happening is the Sor María Ludovica Children’s Hospital. There, of the 25 residence vacancies that occur every year, only four were filled. “Something like this has never happened. And less so in a reference hospital such as Ludovica. All those who are going to be pediatricians want to do their residency there,” says Ana María Arturi, from SAP.
He says that most of the public hospitals that have a pediatric service in the Sanitary Region 11 of the Province of Buenos Aires -which includes municipalities such as La Plata, Ensenada, Berisso-, did not cover their vacancies for residents.
“In all of them, except for the San Roque hospital, which has five offers, in all the others, the offer exceeded the demand for admission. And vacancies remained free,” says Arturi. He assures that this has been happening for several years. “But like that… it was never so rude,” he warns.
Pediatrics has eight 24-hour shifts per month. “It is a demanding hourly load and the payment is bad. A resident who has rent cannot live on what they are paid. In addition, by contract, he cannot have another job, because it is full-time,” explains Arturi.
Pediatrics as a specialty is very demanding and is very poorly paid compared to others. It is a purely clinical specialty.
“Students are unmotivated, already from college. If they have a professor who is a pediatrician and who has multiple jobs, with many poorly paid guards, that discourages them from pursuing the specialty,” says the specialist.
Low salary and heavy workload
Clarion he consulted several doctors about residents’ salaries. “The boy who has just entered and is in the first year of residence, charges 120 thousand pesos“, commented Verónica, a clinical doctor who attends an important public hospital in Buenos Aires. “This is not enough for anything,” she adds.
Upon consultation of Clarionfrom the City Government said that “in the City of Buenos Aires, as of September 2022, a 1st year resident earns a gross salary of approximately $145,000. A staggered increase of 50% is stipulated until the end of year, segmented into 10% in September, 18% in October, 15% in November and another 7% in December”.
Arturi remarks that “it is a slow phenomenon, and it will be seen when it explodes. When people retire and the positions they leave are not covered.”
Many doctors, faced with low salaries, endless hours of work and stress, prefer to migrate to the private sector, where they charge a little more, but the difference is not substantial either. “In the Sacred Heart Sanatorium, a first year resident earns 155 thousand pesos“says a doctor who works there.
“We are working in a dialogue table with the residents seeing the conditions to improve,” they point out from the Buenos Aires Government.
Few doctors received
Another phenomenon is that the number of medical students is also falling and there are also very few who finish their studies. Roberto Freue, who is also head of Practical Work at the Faculty of Medicine of the UBA, says that “on this occasion, with 36 years of teaching in Medicine, I am concerned about the reality of young doctors and students. It would seem that the situation is headed for an irreversible disaster that will seriously compromise the health care of the population”.
He says that each year much less than 10% of the students who start it finish the degree. “About 10 thousand students enter and 600 are received”he argues.
In the last adjudication of residency positions of the Medical Clinic of the Hospitals dependent on the UBA, of 35 establishments, only 16 had at least one adjudication of residents and the total number of adjudications was 66 out of 207 available positions.
“Of those 66, it is very likely that a significant percentage will not show up at their residence, since they were surely awarded in another system,” says Freue.
And he maintains that at the country level the situation is much more serious. “There are entire residences of all specialties that do not have residents. Doctors retire and there are no doctors, these services are not working directly.”
many years of training
For Freue, one of the problems in medicine is that in order to become a staff doctor, a person has to be 12 years in the making. “There are not many people who are willing to study that time to be able to have some money just at the age of 30,” she maintains.
And he adds: “all the systems have serious problems. If it weren’t for the very high flow of foreign doctors that the country has today could not treat patients. At the UBA, 20% of the students are foreigners. But then they go to their countries. Or they are going to do the residency in other parts of the world.”
“The problem with the program of the Faculty of Medicine is that it is not adapted to reality. In the United States, the course lasts four years.. You have to shorten the run. And adapt it to modern reality,” says Freue, explaining that students only set foot in a hospital in the third year of their degree. “They should go to the hospital from the first year.”
Many students prefer to choose more profitable majors. “They migrate from the clinics to other services where they can earn more money for less work”, recognizes a clinical doctor from Argerich.
MG