2023-08-25 04:00:00
The race of medicine it was not born as we know it today; with a basic cycle, a clinical cycle, undergraduate internship and social service. Each stage of formation has its own story. In relation to social serviceDr. Juan José Mazón Ramírez explains how it began: “On December 2, 1935, Gustavo Baz presented to the rector L. Chico Goerne the project for the realization of the Social service of the interns from National School of Medicine; It was his response to the demagogues who accused the University of being elitist and called for a supposed divorce between it and the people of Mexico. In 1936 the Social service mandatory when the first agreement is entered into between a public sector agency, the then Department of Public Health and the UNAM.” (1)
In this brief narration we find one of the documents that define the social service and it is the source of many problems: the collaboration agreement between a health institution and an educational institution. Said agreement should establish the charges, obligations and responsibilities of each of the institutions; but, on many occasions, these are not updated or are not known to the operating personnel and, therefore, they are not complied with. The collaboration agreement is essential. In a good agreement we can find the answer to many problems.
Regarding the legal basis of the social service, In the fifth article of the Constitution, in its second paragraph, it is established that the law of each federative entity will determine which professions need a title to exercise and the conditions to obtain it. In all the states of the republic, the medicine It’s one of those professions that requires a degree. Therefore, the obligatory nature of the title for the exercise of the profession makes the social service something unavoidable in the field of medicine. Both article 137 of the General Education Law and article 52 of the Regulatory Law of Article 5 of the Constitution establish the obligatory nature of social service. Said obligation is also recognized in article 84 of the General Health Law, for which reason the social service –good or bad– is unavoidable to practice the profession.
To understand the legal status of the intern of social service it is necessary to refer to article 53 of the Regulatory Law of Article 5 of the Constitution, where the social service such as work of a temporary nature and through remuneration carried out and provided by professionals and students in the interest of society and the State.
Therefore, the intern of social service It is in a limbo: between the undergraduate intern who is only a university student, the general practitioner who is a professional with a professional license, and the resident physician who is a worker and a student at the same time. The intern of social service He is developing a temporary job, but without being recognized as a worker at the health institution.
This ambiguity in their social status lends itself to many abuses. Since although they should be paid for their work, on many occasions this payment is insufficient and they do not even have money to go and return to their clinic.
The reality is that after almost ninety years of social service in medicine there have been many changes in their daily practice and the legislation It has not progressed at the same pace. We now have a large number of interns carrying out research, administrative and teaching tasks. I think this is not bad, let’s remember that not all doctors are going to be clinicians and all these other activities can also give back to society and are a common practice in other disciplines. It is important to have options for those people who are not going to opt for the job of the first contact general practitioner or specialist physician. The problem is that these diverse realities and options are not reflected in our legislation. For example, while in CDMX only 4.3% of medical personnel in direct contact with the patient son internsIn Oaxaca the figure is 31.6%. In Nuevo León the percentage is 8% and in Michoacán 25% (the national average is 13.3%). At the national level, the way in which the government is articulated is changing. social service. Each entity has its own characteristics and needs, but in all of them we find modalities of social service that are not reflected in the regulations. Undoubtedly, the reality of medical training has changed in the last 90 years, but these changes have not been reflected in regulations.
Regarding the problems that arise in the social service In a document published by the CIFRHS titled: community social service strategy with a focus on medicine Familiar: General Guidelines it is mentioned that in the “Forum analysis of the social service 80 years after its establishment” (2) carried out in 2016, it was concluded that:
1. The social service of medicinein most educational institutions it is not part of the curriculum, so the intern’s academic training is not continued.
2. Educational institutions have little or no contact with doctors interns.
3. The amount of the scholarships is insufficient.
4. There is little availability of technological developments for the clinical practice of the medical intern and for their training.
5. High administrative burdens for the medical intern.
6. The doctors interns they are alone for a year in health centers, which generates a feeling of abandonment, loneliness, stress, depressive disorders and problems of interaction with the community.
7. There is little or no supervision.
8. Perception of insecurity.
Finally, on August 7 and 8, 2023, the UNAM CU National Forum on Social Service and Medical Residences where a large number of health professionals met to discuss the challenges of social service. The conclusions were similar to those of the document I just mentioned. To the partner servicehe needs one remodeling. We have to adapt the social service to the 21st century. Its current regulatory framework is insufficient; but, we must be careful with what we are going to reform. These changes must be made by listening to the people who work every day with interns of social service and the regulations must take into account the needs and characteristics of each of the states. It should not be a straitjacket, but it should establish the rights and obligations of all those involved and have as a pillar the health of the patient and the well-being of the interns. In addition, that at reform the legislationyou should also listen to the interns to find out how people live today social service and how we can improve it.
1. Juan José Mazón Ramírez, The legal framework of social serviceMedical Gazette of Mexico, Mexico, Volume 148, 2012, p.285
2. Visible at: http://cifrhs.salud.gob.mx/site1/ssi/ss_com_enf_med_fam.html
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