An “unreal”, “unviable”, “useless” proposal, “that will favor the exodus of professionals to the private sector or abroad”… The improvised announcement by the Minister of Health, Mónica García, to ban doctors from healthcare public to also practice in the private sector in exchange for a bonus of exclusivity has been interpreted as a direct attack on an already battered profession. «If there is any known case of a head of service who does not visit his hospital and dedicates himself only to his private practice, let it be reported and controlled, but let’s not demonize the rest. “The lazy person will continue to be lazy, with or without exclusivity with public health, because no one controls him,” says a head of service at a large hospital in Madrid who prefers to remain anonymous.
The doctors who get a service head, the responsibility of an entire department, arrive by opposition. But, once that place is won, the Spanish health system does not evaluate its results as is done in health systems in other European countries. It does not matter if the head of service manages to reduce the waiting lists in his department, if he attracts research projects or implements innovative ideas to improve the care of his patients “because at the end of the month he will earn the same as if he did not do so” , assures this head of service, who proposes evaluating the heads of service with objective parameters every five years, as an alternative to prohibiting practicing private medicine. “What is not evaluated is devalued,” he says.
Psychiatrist Celso Arango, director of the Institute of Psychiatry and Mental Health at the Gregorio Marañón Hospital in Madrid, defines the Minister of Health’s proposal as “unviable.” «If now we don’t have doctors to even cover maternity leave, I don’t understand why they want to lose talent. It seems that the minister does not care about the public health situation. This news is going to make all the leaders of Spanish private healthcare very, very happy,” he says.
He speaks, he says, without any conflict of interest “because I must be one of the few service heads of a large hospital who does not work in the private sector,” but he fears the deterioration of the public system. «More and more doctors choose to work exclusively in the private sector because by working less they have a higher salary. Only those who have a great vocation and don’t mind earning less money stay. But we cannot make life impossible for those who stay,” he reflects.
Incentives
In the private sector, the proposal is not understood either. “From our point of view, it would be more important to include productivity incentives within the Framework Statute to pay more to professionals who are more productive, and allow them to choose where they work outside of their working hours,” argues Marta Villanueva, general director of the IDIS Foundation, an entity that brings together the main groups of hospitals and private clinics.
Villanueva understands that in an “ideal” world, professionals should work in a single center or project, but “given the difficulties and salaries of the National Health System, it does not seem the most appropriate.” For this reason, the director of IDIS predicts an exodus of professionals to the private sector.
The unions, for their part, consider that with this measure “it will be very difficult to find people willing to hold these positions,” in the words of Ángela Hernández, general secretary of the Association of Doctors and Higher Graduates of Madrid (Amyts), who assures which explains that these charges usually involve increases of just 300 euros gross per month “despite all the responsibility and all the work they entail.” If there are cases of abuse like those mentioned by the minister, Hernández continues, “there are medical directors and managers in all centers to pursue these types of situations,” but he insists that “they are the exception, not the rule.”
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