Up to 90% of MIRs in family medicine leave the specialty after completing their training | Community

In Spain, there is a shortage of primary care physicians. About 5,000, according to medical associations, which causes a lack of resources in health centers that affects four out of ten Spaniards (according to the CIS) and which collapses the system in critical periods,…

In Spain, there is a shortage of primary care physicians. About 5,000, according to medical associations, causing a lack of resources in health centers that affects four out of ten Spaniards (according to the CIS) and which collapses the system in critical periods, such as the peak of a flu epidemic. Last Christmas. The autonomous communities, especially those affiliated with the People's Party, demanded on Friday that the government call for more jobs for in-house resident (MIR) family doctors to solve the problem, at a plenary session of the Interregional Council of the National Health System (CISNS). . The Minister of Health, Mónica García, has committed to its creation, but reminded them that this is not the main problem: “According to the communities, between 50% and 90% of the MIR [que hacen medicina de familia] “They don't stay after the residency is done.”

This means that even though they train to become family doctors, they later choose other professional opportunities, such as going to work in emergency situations in hospitals, in the private sector, abroad, or even doing another specialty with better conditions. There are many factors that affect this defeat. But there is a vicious circle that is deteriorating the system and has accelerated during the pandemic: doctors do not have enough time to see patients, which makes working in the health center less attractive, which makes fewer and fewer MIRs join them, which leads to there being more and more patients per… doctor …

“We need specialists to have time for appointments in less than 48 hours, long, slow and reflective, for constant follow-up, personalization and a community approach. Without time there is no primary care, and without primary care we cannot have a strong system. Nor The excessive workload, lack of professional recognition, unstable contracts and 60 patients a day consulted must be addressed.“There is no point in trying to create professionals in an environment where patients are being pushed out,” Garcia said in a press conference after the council.

All these powers are transferred to the autonomous regions. They are the ones who hire, they are the ones who provide incentives, and they are the ones who determine the size of the workforce. The consultants have come up with a commitment to improving conditions and stability and trying to make the specialization more attractive through incentives to go, for example, to rural areas, which are usually difficult to cover. Bureaucracy must also be reduced and digitization increased, so that doctors can focus on diagnosis, care and treatment. But in a plenary session dominated by PP ministries, officials focused on the government's only direct remit: creating more family spaces in the MIR. They have requested an increase of 1,000 places per year for the next four years.

The truth is that it has not stopped growing in recent years. In 2024, a historic record was broken, with 8,772 places offered, of which 2,492 were in the family and community medicine specialty. Aside from the working conditions that drive doctors to quit, the current shortage of professionals comes from job cuts that occurred during the crisis, which bottomed out – with 6,098 jobs – in 2016, under the government of Mariano Rajoy.

The increase in places also depends on those places that the autonomous communities have been able to adopt. That is, those that their health systems can generate. It's not just about setting them up, they have to prove they can serve these new doctors who are trained in the system. The ministry agreed to lower accreditation requirements, “as long as quality is maintained,” but also noted that there are communities, such as Extremadura and Castilla y León, that accredit twice as many places based on their population than the average. “We have to learn from them. If they all reach the average, we will be 70 doctors away from reaching the 1,000 they are asking for,” Garcia said.

Remove masks

The CISNS plenary session also worked to withdraw the rule for the mandatory use of masks in health centers, where the epidemic wave of influenza and other respiratory infections had been “controlled,” said García, who thanked the “effort and responsibility.” For communities, professionals and patients during these weeks.

The measure was implemented according to the criteria of the majority of Council members on January 10, when the peak of infections in Spain had already been crossed. Health forced local communities to enforce it in hospitals and health centers until there were two consecutive weeks of declining infections in each province, a situation that some were already in at that time and that others reached little by little.

Garcia reiterated that Health and Communities “got the commitment” at Friday's meeting to start working “from now on” with this latest epidemic data to plan respiratory viruses for next winter.