In July of this year, the Council of Ministers approved the Royal Decree creating the new specialty of Emergency Medicine. It is a historic demand of doctors that opens the way to double degrees with Family Medicine.
Until then, Spain was the only country in the European Union, along with Portugal, that lacked this medical specialty.
“Given that care in emergency and urgent situations has experienced an increase in complexity, for which specific skills are needed, due to the increase in specialization and, furthermore, to be in line with other States of the European Union, it has been “The creation of this new medical specialty has been arranged,” said the Ministry of Health.
Since then, and with the implementation process already underway, Agustín Julián Jiménez assumed the Presidency of the newly created National Commission for Urgencies and Emergencies.
He practices at the University Hospital Complex of Toledo, the province in which he is registered. He is a specialist in Internal Medicine, Family and Community Medicine and Emergency Medicine, as well as the center’s Teaching, Training, Research and Quality coordinator.
With him we talked about the new medical specialty of Emergencies and Emergencies and how it should be configured in the MIR system. The Commission that he presides must address, among other issues, the training program for emergency resident doctors.
He has just assumed the Presidency of the National Commission for Emergencies and Emergencies and will be the first. How did you receive the news of the position?
With surprise. I didn’t expect it. And with great joy because we had been fighting for a long time, 30 years, for the Emergency and Emergency Specialty to be created.
I will have the privilege of being part of the first national commission for this specialty, so for me it is a great satisfaction, but also a great responsibility.
We believe that it is necessary, even though it arrives very late, so that there are A&E residents in Spain’s hospitals as soon as possible.
Why do you think it has taken so long?
Nobody can answer that. There is no answer. It’s absolutely incredible that it took this long. We have been close to achieving it many times. It has been announced by the Ministry of Health, but due to various mishaps, changes in the ministry or ministers… In the end it did not materialize.
I still remember the year 2003. I was part of one of the first promotional commissions. So it seemed imminent. Later that same thing happened on several occasions, but until July of this year 2024 has not been a reality.
After so long, we can say: finally! And from here we enter a new stage to make it happen. We are in it.
What is this National Commission for Emergencies and Emergencies and what is it for?
The priorities of the commission of a new specialty such as this one are to approve or give way to the direct title of specialist.
In a second phase, we hope that those people who have experience and recognized merit can access the title, after a practical exam. The third phase, when we have residents in the specialty, should serve so that they can also apply for the degree. The degree process will take years.
Is there a specific figure that indicates how many people will now be able to directly access the specialty title?
In the decree, the Ministry of Health determined that they would be delivered, according to the months of birth. We estimate that, until April 12, 2025, which is when the application window closes, between 15,000 and 20,000 files will have to be resolved.
We are sure that a large part will have direct access, another group will have it together with an exam and a few will be excluded.
What steps will they have to take to speed up the process?
Apart from the homologation of titles, the priority is to publish the official program of the specialty. We hope it can be in April or May 2025.
A Delegate Commission for Immediate Care has been established, made up of two members of the National Commission of the Specialty of Urgencies and Emergencies, and two others from the Commission of Family and Community Medicine.
They are working on both programs, which will have common competencies, but in reality the training of residents in both specialties will be different.
We cannot do things wrong because we want to rush. We are from emergencies, not rush
The Spanish Society of Emergency Medicine (SEMES) expects that the training of the first MIR promotion of the specialty will occur between 2025 and 2026. How many residents can we be talking about?
Well, the scientific society will want, and does very well, for resident places to be available as soon as possible, but specialized health training and the annual call for places take a process.
Once the homologation of degrees occurs, the official program of the specialty is ready and we have the accreditation criteria – which is what we want to have by May or June 2025 – then we will be able to think about the phase for the centers to training are accredited. That will also take months.
We have to have graduates in Emergencies and Emergencies who act as tutors, as well as accredited centers to train residents. It will then be the moment in which either the Ministry of Health will open a special window to offer these places or they will be integrated into the annual offer.
We all hope that there will be emergency residents as soon as possible, but we cannot do things wrong by wanting to rush. We are from emergencies, not rush.
But isn’t there a minimum number of places for emergency residents?
Yes, yes, many people have talked about minimums, but of course this has to be a coordinated approach between the Ministry of Health and the autonomous communities. They are the first places, which will have to grow year after year, but we must start calmly and safely.
At the moment we do not know how many places the accredited centers will have in the autonomous communities. We all want it to be as soon as possible and with the greatest number of places, but I insist again, we must guarantee that they are properly trained.
More than a base, I would talk about a ceiling. Right now there is a great need for A&E specialists. We start from a historical demand that right now is unlimited.
In Spain there is talk of a lack of medical teachers. Are you concerned that the lack of training doctors could affect this new specialty?
Not me personally. I have been in specialized training for more than 20 years, as head of studies and tutor. It will also be necessary to update the teaching methodology for A&E doctors, but it must be taken into account that these services are the ones that most residents receive, despite not having the specialty recognized. The teaching experience already exists in the Emergency Services.
Is it going to be easy to adapt the new specialty to the university setting, beyond the clinical setting?
Not that it will be easy, but excellent. Until now there was no specialty, but the most in-demand among sixth-year students for the rotary, with a huge difference, is Emergency.
What it will surely allow will be improvements at a functional and organizational level. Are the images of people in the hallways going to disappear in the winters? Hopefully
Can the new medical specialty pave the way to stop repeating images of saturated emergency room corridors?
I wish it were like that, but that’s something different. What the new Emergency specialty will allow is to structure and prioritize spaces, services, operating rules and even patient flows.
Of course, what it will surely allow will be improvements at a functional and organizational level. Are the images of people in the hallways going to disappear in the winters? I already told you that I hope so.
I ask because the progress for professionals is evident, but perhaps the patient wonders if this will also result in an improvement in health care.
People have to know that this will mean security for the care and for the professional. When there are A&E specialists, there will be qualified and trained professionals in a homogeneous manner, as when one goes to the cardiologist or nephrologist. Right now that guarantee does not exist. It can only bring benefit to the system, to the professional and to the patient.
The on-call system in Emergency Services will be regulated, which is now different depending on each hospital and each autonomous community. Now they are going to be structured with real specialists
Is the specialty in Primary Care Emergencies ruled out?
That was made clear by the ministry and the autonomous communities. It was decided in the Interterritorial Health Council.
How many medical professionals are there now in the Emergency Services in Spain?
There has always been talk of more than 20,000 emergency doctors. Another thing that will happen is that the on-call system in the Emergency Services will be regulated, which is now different depending on each hospital and each autonomous community.
There are many residents from different specialties who do them and now these shifts are going to be structured with real Emergency specialists. They will depend on the specialty templates, not on other doctors. Residents from other specialties will not be considered part of the staff.
We have just seen how our country was devastated by the consequences of a DANA. Is the specialty going to serve to improve disaster management?
Without any doubt. There is no specialty that has disaster management and assistance in accidents with multiple victims in its training program. Now A&E professionals will have this type of training.
Although the teams are capable of acting in an exemplary manner, it had not been regulated. Now it will be protocolized. It is another undoubted improvement in quality assurance in care and in the health system itself.
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