Dissatisfaction among the staff at Hospital 12 de Octubre in Madrid due to the latest decision by the Community of Madrid to reorganize shifts. The clinic’s management has informed the heads of each service that, in 2025, doctors from other specialties will have to support the Emergency Department and neglect, to a certain extent, their usual responsibilities.
An internal communication to which this newspaper has had access and which was released on December 19 reports that support will begin to be provided as first-call doctors in the wards of all health workers. Also, and here is the controversy, those who usually do not correspond to the tasks of continuous care. Other coordinators must first give their approval. The main argument put forward is that this will control the “overcapacity” of the Emergencies. This alternative operation will go live on January 7.
The measure will only affect some patients, those in the Priority 3 and Consultation areas, whose situation is urgent but somewhat more stable than the rest. The most serious cases will continue to be treated by emergency doctors, but all health workers will have to use their guards to provide support for continued care, from three in the afternoon to eight in the morning from Monday to Friday and on weekends or holidays. . 12 de Octubre has different areas of specialty, in addition to hospital emergencies: Allergology, Digestive System, Cardiology, Endocrinology and Nutrition, Intensive Care Medicine, Internal Medicine, Nephrology, Pulmonology, Neurology-Neurophysiology, Psychiatry, Rheumatology and a Multidisciplinary Unit of Pulmonary Hypertension.
To distribute all these professionals in the new shifts there will be a facilitating doctor, that is, a coordinator who will decide who can provide this service among the specialists. According to the note distributed among the health workers, care will be taken “at all times” based on a “proportionality criterion, avoiding asymmetries in loads” and with the support of the Chief of Guard “if necessary.” The measure will affect all specialties in these two ways: either by referring one of their doctors daily to support the Emergency Department, or by incorporating their services to this department during their on-call hours.
One of the health workers affected in this last case, who does not belong to the Emergency Department but prefers to remain anonymous, explains to this newspaper that in his case he has not performed tasks that would normally correspond to family doctors or internists for decades. In this way, he tries to explain how in his opinion the new change with which he wants to start the year not only affects the specialists, but “also puts the patient at risk.” Furthermore, it highlights that this type of “controversial actions” always arrive on the same dates, during summer vacations, Christmas or other long holidays.
Emergency care that day will be prioritized over the rest of the scheduled activities.
At these times, not only does information flow decrease, but vacation gaps also increase and staff shortages become more noticeable. This last measure, in principle, will only affect experienced doctors. That is, it will not apply to residents. The facilitator will in all cases be an assistant to the Emergency Service with a long history, becoming the reference figure for his non-specialized colleagues. He will also be in charge, according to the hospital management, of “reorganizing the activity of the residents” and prioritizing their activities, “supervising their decision making” and identifying the most complex patients to treat.
From the Department of Health of the Community of Madrid, reproducing the words of the hospital directive, the explanation is concise: “We reinforce emergencies with 7 and 12 hour modules of doctors according to need, as we have been doing for more than a year” . However, center workers and Amyts sources deny that this has happened before. As noted in the document issued by the management of Hospital 12 de Octubre, not all specialists will generally treat any pathology.
The idea is that the treatment depends on whether the urgency is more related to a heart problem, which a cardiologist would see; with a continued chemotherapy process, in which case a hematologist would assist, etc. The initial program establishes a series of criteria that define the circumstances under which one specialist or another must respond, in general terms.
“These shifts will be distributed among the list of available doctors by the emergency coordination, 3 months in advance. Any change or need for adjustment associated with the needs of the service in which the affected physician provides care will be communicated to the Emergency Service, who will try to reconcile the best solution among the possible ones, considering that emergency care that day will be prioritized. regarding the rest of the scheduled activities,” the document ultimately states. That is to say, from January 7, the important thing will be emergencies, even if this is despite the rest of the services.
According to one of the doctors at the hospital, October 12 has “many people on sick leave” forcing them to make up for these shortages, and above all “very few professionals for the workload in the Emergency Room.” In part, he believes, because the Community of Madrid “does not make this job attractive”, the influx and demand of the service being well known in contrast to “conditions that leave much to be desired”, points out this health worker. He explains that there are positions that lack bonuses with which other communities reward their doctors, thus increasing the base salary established by law. “Sometimes we have been specifically asked to support the ER when there is less staff. With the coronavirus we all pitched in more than ever, knowing that in that case there was no other option. But I believe that what is happening now comes from a basic error in the regional government,” he concludes.
Another doctor from the same center adds that, although at first it was not specified whether the measure would be temporary, after the initial “commotion” over the calendar sent, they sent “a new email correcting the previous one and explaining that this model is provisional while they try to resolve it.” with the Community of Madrid.” In his case, he evaluates the hospital’s performance negatively. “It should be solved like in other centers: with stable contracts for doctors trained and dedicated to emergencies.” As he sees it, the clinic where he works “is only offered short-term contracts that are not covered due to their poor quality,” so that the staff “is lower than the demand.” [600 urgencias en la actualidad] in relative terms with respect to other large hospitals in the region.”
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