President Andrés Manuel López Obrador yesterday reiterated his commitment to achieve universal and quality health coverage, an objective that, he said, has been hampered by difficulties in hiring medical personnel. After attributing this complication both to the abandonment of training work in the past six-year terms and to the reluctance of the doctors to fill the vacant positions, the president assured that in order to guarantee “medical attention 24 hours a day, seven days a week, week”, options such as bringing doctors from other countries and offering salary increases to nationals “to cheer them up” are analyzed.
It is the subject of debate whether or not, in purely numerical terms, Mexico has a sufficient number of health professionals to care for the population. For the World Health Organization (WHO), our 241 doctors per 100,000 inhabitants are slightly above the minimum floor of 230 per 100,000, while the Organization for Economic Cooperation and Development (OECD) places us in a marked deficit with respect to its recommended rate of 320 per 100,000.
However, such figures hide dramatic and even tragic regional differences: according to the Ministry of Health, 40 percent of the 135,000 certified specialists are concentrated in the state of Mexico and the country’s capital, in contrast to most of the Territory: In the middle of this year, there was not a single pediatrician to care for the 2.4 million children in the Huasteca, La Montaña, and the Papaloapan-Olmeca region of Veracruz, a scenario that is repeated in the state of Guerrero. These differences prevail despite the efforts of the current federal administration to correct the gaps. For example, 47 percent of the applications for the call launched last May were concentrated in four states (Mexico City, Jalisco, Puebla, and the state of Mexico), but not a single doctor raised their hand to occupy one of the 9,000 725 posts in 3,339 municipalities with less than 200,000 inhabitants, rural areas and indigenous communities.
The data presented contains an obvious moral: no investment (however important it may be) in training general practitioners, specialists, technicians and nursing staff will result in relief for the health system as long as the disdain of these professionals for going to the clinics persists. regions where their presence is most urgent. Doctors and their union organizations cite the insecurity crisis that plagues a large part of the country as the reason why they refuse to work outside the large metropolises, but it is clear that this factor does not exhaust the explanation of a structural problem. This is demonstrated by the fact that the UK public health system is facing a catastrophic attrition of dentists for one reason only: they are migrating to the private sector in order to increase their income.
From what we can see, we are facing a raid on the mercantilist logic in the medical profession: the choice of the career itself, the specialty to be followed and the place of work is usually determined predominantly, if not uniquely, by considerations pecuniary This problem has its roots in teaching, with educational centers as the first representatives of an ethical shift that promotes personal benefit on any aspect; the search not for where to serve, but where to prosper.
Reversing this perversion of medicine is a long-term task that requires, it is true, to provide decent conditions for the practice of the profession in the public sector, but above all to transmit to students and new technicians and professionals the intrinsic nobility of his trade and the dangers of reducing it to a mere instrument for accumulating personal wealth.