Considered the jewel in the crown of Andalusian Public Health, Primary Care is a mistreated area in the health system, according to the workers themselves. Access door for citizens to take care of their health, most of us turn to our family doctor to treat any ailment and while the population continues to grow, the number of family doctors is only decreasing. In Andalusia, whose population exceeds 8.4 million inhabitants, there are about 110,000 health workers among doctors and nurses from different specialties, of which 7,800 are family doctors and pediatricians who work in Primary Care. In other words, according to the data, 7% of Andalusian health workers serve 95% of the population. Figures that portray the healthcare imbalance in which Primary Care has been installed in Andalusia and which causes the problems that family doctors face on a daily basis.
The situation is seriously affecting this specialty because the work overload and stress accumulated by professionals is weighing it down, taking it to the limit of “collapse”. To the point that they fear that the situation will become untenable in a short time. Andrés Jiménez, member of Primary Care at the Andalusian Medical Union (SMA), says that the specialty “is not attractive due to many circumstances.” The main one is the overload of work they have, with an average of 60 to 80 patients a day, depending on the day and the health center. “In the capitals they cope better than in the towns because there is a certain percentage of the population that has private medicine and does not use public medicine.”
“In the towns, urgent things have to be attended by the family doctor at the health center on duty,” says Jiménez. In addition, in Andalusia there is a concept called “zero delay” and which means that the patient must be treated as soon as he enters for a consultation with a family doctor. Something that does not happen in hospitals because specialists have their appointments assigned: “In Primary it does not matter if you have 60 or 70 patients, that if the person arrives and needs to be seen today, they have to see it.” As the average time of attention per citizen can rarely exceed 5 minutes per patient, this ends up affecting the way of attending to them. The doctors denounce that this circumstance prevents them from doing an optimal follow-up because they can hardly explain or perfectly analyze what their clinical picture is.
Added to these problems is the overload that comes from hospitals. “Everything that, in quotation marks, is left over in hospitals (minor surgeries, control of the simtrom, cytology for women …) ends up falling on us. Family doctors are trained for almost everything, but if they give us more work and we have less time, there is no body that can take it ”. On the other hand, Jiménez recalls, “the population is increasing and demands more medical attention”
According to the member of Primary Care of the SMA, “the salary is not the biggest problem.” Today, they perceive some 1,100 euros gross monthly base salary without supplements nor overtime hours that can amount to around 2,300 euros in base in the youngest family doctors who accumulate a couple of three years and go up to just over 3,000 euros gross in the same circumstances in those doctors who accumulate about 30 years of career. Of course, “almost 40% of the salary is obtained from the guards.”
However, there are more problems. The geographical dispersion and the difficulty to reconcile a more or less dignified work and personal life make doctors think about it when accessing this specialty. “It is not the same to work in a regional hospital or in a capital, than to be in the most distant health center that you can think of.” Jiménez believes that it is relevant that “most prefer a temporary contract in the emergency room of a large hospital than a fixed position in a place that is far from a city with many services.”
Gloria Magana She is one of those health workers who knows what it is like to chain temporary positions in various municipalities over time. At the age of 62, just a few months ago he got a job to work in Granada. “I have spent 35 years of my life going from one place to another, chaining contracts.” A situation that reveals the other great problem that primary care in Andalusia faces: there are hardly any oppositions to expand the workforce.
“In all this time, there have only been four opposition contests,” laments Gloria. She, who is about to retire and who had to go back to work after overcoming cancer because Social Security considered her suitable, understands that young people do not want to accept the working conditions that family doctors suffer. In addition, his case is an example of the thinking that more of his professional colleagues have: “As there are no competitive examinations, the staff is aging and there are more and more retirements”.
As if that were not enough, from the Andalusian Medical Union they assure that the losses of those who retire are not covered because there are few oppositions -between 2011 and 2015 the Government of Rajoy established cuts that prevented covering the places of retired health and health care-, but neither temporary places because there is a lack of a bag and those who opt for one of them prefer to avoid it. “There are municipalities in which there are 10 permanent jobs as a family doctor, of which only two of them are covered. The health workers prefer to lose their place or repeat the MIR (Internal Resident Physician) to look for another specialty that has better working conditions ”, says Andrés Jiménez, member of Primary Care.
Julia, who gives a fictitious name for fear of reprisals, is a young doctor who works in Andalusia and knows exactly what her colleagues suffer. “Have I ever thought about throwing in the towel and giving myself some time or even doing the MIR again. I know people who have done it ”. The doctor regrets that these circumstances are present because she considers that her specialty “is very beautiful, but it is mistreated.”
It is also not easy to establish how many personnel are missing in each center because the Andalusian Health Service (SAS) is opaque in its figures, according to the health workers. A problem to which is added that doctors have to do home care after strenuous hours. “We have to move around spending our time and our memories and we barely have 20 minutes per patient, which does not always allow us to spend a lot of time with them if we have to go see someone else immediately.”
On the other hand, he says that the Covid-19 pandemic has made a dent in the problems that this area of Primary Care has. “There are colleagues who were older who have passed away. Others who have had to leave or have preferred to retire and in general a lot of stress has accumulated ”. In part, he says, because to avoid being present, the Board started up the telephone consultations. “They are difficult because sometimes the patient does not pick up the phone and misses the appointment. On top of that, they cannot be followed up well because we need to see them ”.
“Due to my medical history, I cannot attend consultations related to coronavirus. This happens in other cases and causes other colleagues to have more workloads, ”says Gloria Magaña. Furthermore, all the health workers interviewed agree that there is a lack of “health education” in Spanish society. There are those who go to the doctor unnecessarily and, although they do not blame them, they believe that, if they had more time to spend the consultation, they could explain to them that it is not necessary to go for certain consultations and that would reduce their workload.
“The solutions are to make this specialty more attractive. That work and family life can be reconciled. It is true that things have been done, but the objective of encouraging family doctors so that they do not have problems going to a health center that is far from where they have studied or grew up has not been achieved, ”understands Andrés Jiménez , member of Primary Care of the SMA. “We need a larger staff to end this overload of patients.” Especially for the summer. A time when vacations, especially necessary after the pandemic, leave empty consultations. What results in stress for doctors and patients who end up causing violent situations. “Above all, we are alone in many centers, there is no security,” says Julia.
From the Andalusian Health Service (SAS) they recognize that there is a problem in this specialty. For this reason, sources consulted by elDiario.es Andalucía indicate that they are in talks with the unions to carry out the ‘Agreement for the Stability and Quality of Employment and Professional Development’ that was proposed in July 2020. A pact that, they assure, also has allowed staff reinforcements due to the Covid-19 pandemic.
“The Sector Board has agreed to carry out an evaluation of the improvement measures already implemented and to continue moving forward to make effective other legislative commitments related to improvements in remuneration and the working conditions of the professionals of the system.” In general terms, according to the SAS, “the negotiation elements include continuing to promote job creation with staff increases in the different categories, professional career and evaluation of professional performance.”
In addition, they say from the SAS, “the areas of difficult coverage also have special treatment in terms of score on the stock market and in public job offers.” Therefore, they announce that “after solving three oppositions and a transfer contest, the workforce has stabilized at more than 30,000 professionals in all categories and contracts for less than 6 months have been abolished.” Finally, it is expected that before the end of the year 1,059 Primary Care places will be put up for tender.