1. The MIR system
The germ of the current MIR system was the ‘Seminar of Hospitals with Graduate Programs’ (SHPG) created in 1967 by 9 highly prestigious public hospitals. The MIR system was generalized throughout Spain in the decade of 70’s. To practice Medicine in the Spanish Public Health, it is necessary to have a specialty obtained by the MIR system. For this, it is necessary to pass the annual exam, which is the same for all applicants and is carried out simultaneously in all communities.
The results allow ordering all the doctors so that, in order, they choose the specialty and the hospital where they will perform the specialization. The excellence of the MIR system It is achieved because the Teaching Units meet the criteria established by the National Commissions, necessary to access the training of specialists.
2. Las National Commissions of each Specialty
There are as many Commissions as there are medical specialties. Is it so formed by 9 medical specialists. They elaborate and, with the evolution of the specialty, modify the specialty training program correspondent. This program is unique for all the independent Teaching Units of the Hospital where the training is carried out. In addition, they must accredit the Teaching Units, prepare the question banks for the MIR exams, etc.
3. The National Transplant Organization (ONT)
His excellent organizational activity has allowed Spain to be the first country in the world in transplant activity. Its results, maintained over time, make the image of Spanish Health in the world excellent. But Spanish Health has a ballast that continually discredits it: the waiting lists.
In Spain, in the 17 health systems that manage Health, there are waiting lists for any medical activity. It is imperative to definitively fight against this scourge. We all agree that one of the reasons is that lack of doctors, an old and known problem on which not enough action has been taken. In addition, measures must be taken to retain these doctors, so we must act in these fields: labor, professional and economic.
The original system did work.
A bit of history so as not to repeat the mistakes: In the first years of democracy it was decided eliminate the medical job as an interim. When competitions for medical positions were called, the doctor with an interim position, with the accumulation of points that were awarded for the years of interim work (so that they were recognized for the years they had been working, but that were balanced without the the rest of the contestants felt that it was an impossible barrier to overcome), I was obliged to appear in the competition for his place. If it did, problem solved. If he did not obtain it, he continued in his position as interim “ad personam”, having to compete whenever his position was summoned. There were no problems because even then there was a shortage of doctors and the vast majority of interims got their place that was already owned.
In order to avoid that the problem of interim reappearance and that the job that was obtained was steadyit was decided and so it was done, that Every six months, all vacant positions will be put up for competition. that exist in any field of Public Health. These positions could be vacant because they had not been filled in previous competitions, due to retirement, death, transfer or because they were newly created. Logically, the places that had been decided to be amortized did not come out to contest.
In each competition, places were reserved for transfers (transfer competitions). If these places were not covered, they were offered in the General Competition. It allowed doctors to settle in the place that was most convenient for them. This system worked to the full satisfaction of all doctors, with a health system attended by happy doctors, with job stability.
Work environment errors
The primer error occurred in 1985, when the Ministry of Health decided that this system of provision of places in health it was not suitable and he suspended it. But since doctors continued to retire, get sick, die, or leave public health and no competitions were called to fill existing vacancies, the interim reappeared. This allowed those vacant positions to be adjudicated, with hardly any control, which were taken advantage of by friends or relatives of the leaders on duty and even, occasionally, a suitable doctor who “passed by” was hired.
Second error. This did not end here, because medical work always increases, and it began to be carried out employment contracts for “accumulation of tasks” to carry out guards, with one-day contracts, that of the guard. The abuse that occurred at that time was great. The doctor felt mistreated, belittled, like a pawn, yes, with 6 years of university studies and 5 years of MIR work. The positions were covered by OPEs, which were convened on a discretionary basis when that autonomy deemed it necessary.
Third mistake. With the health transfers to the autonomous communities and these OPEs the transfer contest disappeared. This had to jump somewhere. Recovering the illusion of doctors is achieved with labor, professional and economic recognition.
Labor solutions:
- Let’s go back to the semester contest for the provision of places in public health. There will be satisfactory job stability. It will avoid the Interim and all the doctors will have gone through an opposition contest with the characteristics of Publicity, Merit and Capacity.
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Let’s go back to the transfer competitions between regions. A doctor with a position obtained by competitive examination in an autonomous community, must be sufficient accreditation to work in another autonomous community. All happy with the possibility of exercising where they like best.
Mistakes in the professional field
The Health managers should always treat doctors with respect, your work and your ability to organize work professionally. Must solicit your feedback on an ongoing basis for all medical aspects and those that refer to the work carried out by doctors: organization of medical work, workloads, long hours, habitat in which to develop them, requirements to progress in the professional career, etc.
Must consult also with the different health organizations: National Councils of the different health professions, Official Colleges of Physicians, Scientific Associations of different specialties and their Federation (Facme), the Forum of the Medical Profession of Spain (FPME), Health Unions (CEMS), the National Conference of Deans of Faculties of Medicine and the State Council of Medical Students (CEEM). Farmaindustria is also available. And even patient associations, such as ALCER, or health NGOs such as the AECC.
According to the professional career should be the objective form of that considerationWell, a level 3 doctor, for example, is a doctor who, in addition to his excellent initial training, has accredited many years of serious and quality work.
Salary linked to professional career
The retribution of doctors should be rewarding and stimulating. It is clear that in the countries with which we always compare ourselves, doctors are better paid, but life is also more expensive. Nevertheless, substantial improvement is needed of the current salaries of Spanish doctors. The remuneration of doctors must be in relation to the years worked and the level reached objectively, through the professional career. Is can solve the issue professionally and economically. Characteristics: five levels, agreed, objective, automatic, attractive, with remuneration by levels with significant amounts.
conclusion
The current problem of Health cannot be solved with patches and mending, but with a long term planning, started from now on with actions in the sense previously explained. Health will begin to improve clearly and verifiably from the knowledge of this path of positive reform. Some actions will hardly have an economic cost, but it will be necessary to dedicate more money to healthwhich I believe and hope will be more efficient, that is to say, that the available resources will be applied with reasonable criteria, by having workers who are highly qualified and who will be happy.