Saturday, October 1, 2022

The crisis of medical generalism in Catalonia

Disappointing results in the choice of the specialty of family and community medicine in Catalonia, and especially in remote areas of large cities, forced a rethinking of the generalism understood as the professional practice of broad clinical medical specialties. We do. Some reflections about the future:

1. Shortage of doctors

Looking at the bulk now, and even more so in the future, there will be a shortage of doctors. Certainly, the ratio between retirement and graduates in the Catalan faculties of medicine in the next 10 years indicates this. Well, we’ll train more doctors, but we must ask ourselves: what to do? What other professions can do instead of doctors? In what ratio generalists/experts?; How will we train doctors to stay here and not migrate? To what extent will technology facilitate the work of generalists? Many questions to discuss…and decide.

2. Selection of candidates and distribution of MIR specifications

Some attempts to improve the training programme, such as changes to the core content, or the MIR exam, or the deployment of LOPS, have yielded less than expected results. Corporate interest and lack of agreement and political decisions are the main reasons. If the management of MIR was decentralized, do we have enough consensus to consider it in the long term?

3. The Case of Family and Community Medicine, a Concrete Example of the Crisis of Generalism

The current situation is a disappointment for the health system which is committed to a specific model that young doctors turn their backs on. Prospective candidates or, with greater numbers of female candidates, opting to choose other specialization paths that allow them better working conditions, are more likely to be able to devote themselves to teaching and research or to family reconciliation. Doctors who choose it have fewer facilities than hospital centers to pursue an academic career that encompasses all that. A profound change must be made from the outside and inside of the attribute.

4. Union of Generalism

Strategic union between generalist specialties (fundamentally family and community medicine, internal medicine and geriatrics) must occur to find a common solution to the current situation. This crisis should be an opportunity. So far, this collaboration has been punctual and more personal than institutional. Some disagreements are the result of differing opinions as to which functions correspond to one characteristic or another. Good coordination between primary, hospital and socio-health care should be an advantage to the health of citizens in a framework in which understanding between professionals is built on protecting one another and the other. The visibility and social value of family and community therapy will be reinforced. The health administration must commit to this strategy, which should also include a review of remuneration models.

5. Determining Role of Faculties of Medicine

Fifty years have passed since the selection and training of medical specialists passed from universities to the health and educational administration of the Spanish government. Over the years, the Faculty of Medicine has been making efforts to adapt its study plans to European standards, but despite all the weighting of students’ academic curriculum, it is only 10% when they graduate and, therefore, mainly Depends from MIR exam. A position denoted by the deanship of faculties that limits the effect of forming a degree in a later specialization.

However, the desire and conviction of most current medical faculties that those they train are general practitioners, who will later specialize, and the growing inclusion of family and community medicine physicians as university professors makes generalism more present in the classroom. Will happen.

6. Listen to the New Generation of Doctors

We are facing a generational change that has never been seen before. The feeling is that many of the things we seniors think or transmit are not part of young people’s life expectations or, perhaps in some cases, they are, but they realize that they have already had a bad experience. Is. The future of generalism should take into account their point of view, even if they are students. This debate can provide us with useful information to revise all of these changes that we feel need the training of young doctors.

All institutions involved must reform health and university systems to change the situation for the benefit of citizens’ health and professionalism.


Ramón Pujol Farioles is Dean of the Faculty of Medicine of the University of Vic-Universitat Central de Catalunya

Marina Gelly is the general director of the Fabrega Foundation for Higher Studies in Health Sciences. University of Vieque-Central University of Catalonia

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