From 32 days to six months: this is how the wait for the specialist multiplies depending on the hospital you go to in Madrid

Madrid’s hospitals and specialty centers are increasingly accumulating more patients waiting for a consultation with a specialist. The problem is not so much the average delay but the large volume of people who are waiting for an appointment – ​​12% of the population, the highest rate in Spain – and the unprecedented escalation of the proportion of patients who are forced to wait very long times.

Beyond the general photograph, the data published by the Ministry of Health allows us to delve deeper into the situation in each public hospital. The analysis of the figures carried out by elDiario.es reveals great inequalities between centers despite the fact that they all belong to the same network. The following example is enough: in the specialty with the most traffic jams, dermatology, the waiting range ranges from 32 days at the Jiménez Díaz Foundation to 191 at the Ramón y Cajal hospital.

The following map shows the inequality in the wait for the specialist in each hospital in Madrid. Select a clinical area and check which centers are the most saturated.

There are centers with very long waits in all specialties. La Paz, one of the flagships of Madrid’s health system, has delays of more than 100 days in a dozen branches. While other large hospitals, such as Ramón y Cajal, concentrate the greatest congestion in specific specialties – in this case, dermatology, traumatology, gynecology and pediatrics – which alter the average. However, the hospital that breaks the delay record, with an average of 107 days, is a center located in the periphery and of a medium size: the Príncipe de Asturias (Alcalá de Henares).

Six specialties accumulate an average wait of more than five months in Madrid. Patients who go to dermatology in the Ramón y Cajal, La Paz and Príncipe de Asturias hospitals, allergy in Puerta del Hierro, traumatology in Ramón y Cajal and neurology in Niño Jesús remain on the list for more than 150 days (around five months) to be attended to.

A map that draws not only a list of overcrowded hospitals, but also clinical areas where patients typically wait months to see a doctor. In the following graph you can see which hospitals have the most saturated areas in each specialty, according to the most recent data as of October 2024.

Even in the most saturated specialties, four Madrid hospitals manage to maintain waits. They are General de Villalba, Infanta Elena (Valdemoro), the Jiménez Díaz Foundation and King Juan Carlos (Móstoles). None of the four have average waits of more than two months for the consultation with the specialist. They all share the same characteristic: although their ownership is public, management corresponds to the private macro-group Quirónsalud.

“This modifies the ecosystem. Someone who has the capacity to handle a lot of volume is introduced because they have incentives to do so,” analyzes Salvador Peiró, who researches health services and pharmacoepidemiology at the Fisabio Foundation. Privatized hospitals receive an extra financial allowance for each patient from outside their area that they treat, whether for an outpatient consultation or surgery. These people can arrive at the hospital after being referred by the system itself, which offers an earlier appointment that can be accepted or rejected; or at the initiative of the patient.

And here another singularity of the Madrid system emerges that conditions how patients flow within it: the freedom to choose a hospital center. Each patient, regardless of where they live, can choose which hospital to go to. “Large differences in wait times are always disconcerting, both for those of us who study them and for the patients, but there are many factors that influence this. This is one of them,” states José María Abellán, professor of Health Economics at the University of Murcia.

The following table shows the inequality: the four hospitals where the wait is less than a month (on average) in Madrid are those managed by the Quirón Group.

In addition to the ability to choose, the professor points to other conditions that can explain the divergences, such as the structure of the population that is served – how rich or poor the area where a certain hospital is located will determine the pathologies that are treated in quantity. and in typology – or the management tools of each center to eliminate waiting lists.

“In privatized ones, the money follows the patient and that can be transformed into hours of work. The more patients, the more money you have and you send more patients at the same time,” explains José Manuel Freire, former PSOE Health spokesperson in the Madrid Assembly and professor at the National School of Public Health, who assures that this does not necessarily mean that management is better but that the public sector, as it is configured, “forces us to swim with our hands tied behind our backs.”

“Subjection to private law gives more flexibility when it comes to organizing: being able to double shifts, opening operating rooms in the afternoon… This fact may offer an explanation for why this happens, but also the size of the hospitals. That is, what type of processes they can offer. If they are easier to attend to, the wait will be more dynamic and will tend to decrease,” elaborates Abellán.

The general secretary of the Amyts medical union, Ángela Hernández, believes that we must make “self-criticism” about these data. “We have to do better. In the public sector there has been no transfer of professionals since 2011, we are forcing people to work in the same place whether they get along well or badly and there is no evaluation of management, the normal thing is that someone is appointed and ends their working life there,” He gives as examples of certain rigidities that afflict the system.

What all hospitals do have in common are the specialties that have the most waits. The coincidence also occurs at the national level. Dermatology and traumatology usually lead all classifications. Because? The plug, experts say, responds to structural problems that have been dragging on for decades.

“When Social Security was created, everything was very focused on surgery, so certain specialties, such as dermatology, have a structural deficiency. In the eighties there were only dermatologists to care for admitted patients. Our MIR training depends on our capacity to train, that is, each center says how many it can teach and if there are few… it drags,” explains Peiró.

In the case of Traumatology, he continues, “specialists assume many things that rehabilitators in other countries would do.” “Back pain is sent to trauma when it doesn’t always make much sense for it to be so.” According to a study commissioned by the Ministry of Health to evaluate how professional staff will evolve in the future, dermatology will have a “slight” surplus in 2029 and a “moderate” surplus in 2035. Traumatology, however, will suffer a deficit of professionals if They take into account the demands of the population for then.

Beyond the detail, the promotion, in any case, is transversal in the waiting lists of the Community of Madrid in recent years. The upward trend is repeated if we look at the figures in most hospital areas. See the following graph for the monthly evolution of the average wait for all specialties in each hospital in Madrid.