Low medical salaries and lack of shifts: the main lack of public health is management

The dissatisfaction of doctors with their salaries es a constant in public hospitals and induces to claim for more budget. The conflict in Córdoba (17 of the 30 doctors on duty at the Río Cuarto provincial public hospital resigned because the basic monthly salary is barely $75,000) shows us that it is not a question of more budget, but of better management.

The modality of how the protest was implemented and the low salary generated a wide reception in the medical community and in the population in general. Naturally, low wages are cause for discomfort. Since the administration of the hospitals is in charge of the provinces, the immediate reaction is to demand a greater participation in the provincial budgets.

The main lack of public health is not resources but management

Contemplating that there is no public information for all the provinces, an approximation can be made based on the province of Córdoba and that is extensible to others. In the public hospitals of Córdoba, there are approximately 4,600 doctors hired for 35 hours per week. Deducting dead time and assuming that they make 3 consultations per hour, each doctor could attend about 330 queries per month.

The City Government reached a salary agreement with the Buenos Aires doctors. (Photo: NA).

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Likewise, 1.5 million people live in the province without medical coverage. Therefore, the total number of consultations that the public hospitals of Córdoba could attend is approximately 18 million queries per year. And assuming 6 medical consultations per year per person, to care for the population without social work, some 9 million consultations per year would be needed.

Under these assumptions, the potential supply in hospitals would double the needs. Although they are approximate data, they suggest that the main lack of public health is not in resources but in management. Hiring more doctors than necessary implies that the salaries of working professionals could be raised if salaries were stopped for those who work little or do not work. In this regard, management failures generate unfair wages because they do not allow for a monetary recognition that reflects the very different levels of commitment of professionals. Management failures are even more unfair to the people who must do queues at dawn for a shift and often ends up not receiving the corresponding attention. That’s why the guards are full.

The other problem is the lack of registration of doctors and patients

The management deficits are reflected in the faulty identification of the people that the hospitals care for, from which a weak control of the task carried out by the staff is derived. Not having good records of the patients and the professional who attended them are the two main sources of wage injustices.

Working doctors are clearly paid bass. While the doctors, who only go a few days and see a few patients, receive the same salary. The consequence are very low wages for those who work and high wages for those who work little.

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In itself, public hospitals need a structural change in its management model. What prevails is a strong administrative centralization in the provincial Ministry of Health and the tendency to appoint as hospital director a staff doctor from the same hospital and not a professional health administrator. His function becomes to process files to manage personnel, the purchase of supplies and maintenance investments in the departments of the Ministry of Health.

The change should be based on the professionalization of management to decentralize management and, with a patient personalization system, monitor health care. Thus, with current resources, doctors’ salaries could be improved. The Ministry of Health of the Nation should transform into an agency for the evaluation and measurement of health results, disseminating them to society. Thus, the provincial authorities will be subject to control and pressure from society to maintain professionalism in the management of public hospitals and thus better pay doctors.

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