96.4% of the residents concentrated five or more monthly guards
The Region of Murcia ranks as the second community with the most non-compliance with the MIR schedule. 96.4% of the residents concentrated 5 or more monthly shifts, according to a study presented by the General Council of Official Colleges of Physicians (CGCOM) carried out on 2,035 MIR doctors, of whom 65.3% were women.
The study seeks to find out the degree of compliance with labor legislation in relation to maximum working hours and number of guards. In Spain, the legal framework applicable to medical specialists in training is included in the transposition of the European Labor Directive, which provides for three fundamental issues: the maximum working day of 48 weekly hours in the semi-annual calculation of effective working hours; daily rest of at least 12 hours between working days; weekly rest of at least 36 hours per week or compensatory rest of 72 hours in two weeks.
In this sense, the data order from highest to lowest the degree of non-compliance with rest after shifts according to the type of specialty: surgical (39%), obstetrics and gynecology (14%), non-assistance medical (14%), medical assistance ( 11%), Family and Community Medicine (7%), ICU-Anesthesia (6%) and Pediatrics (3%).
By Autonomous Communities, the list is headed by La Rioja with 100% of residents with 5 or more monthly on-calls, followed by the Region of Murcia (96.40%), Castilla-La Mancha (92.09%), Galicia (91 95%), Asturias (91.3%) and Extremadura (90.38%). On average, the number of guards in the last month was 5.01 guards and in the last 3 months 15.03. The communities where the highest number of on-calls were carried out on average were Asturias (5.6), La Rioja (5.5) and Extremadura (5.3). The existence of an average of 5 or more guards per month supposes an excess in the number of hours established by European directive.
Included in replacement lists
Likewise, the report reflects that 50 percent of residents in Spain are included in substitution lists. Also called ‘blacklists’, these are used in breach of the law to force residents who are not on call to cover a last-minute sick leave in the event that a doctor cannot come to perform their duty without any type of compensation for having said availability. By groups of specialties, surgical specialties are the ones in which the most residents are included in substitution lists (60%), followed by Family and Community Medicine (55%) and non-care medical specialties (52%).
As highlighted by Domingo Sánchez, national representative of the national section of young doctors, working more hours than legally established and not taking mandatory breaks are closely related to the deterioration of the psychosocial well-being of MIRs in relation to the increase in of the rates of mental health problems and burnout. This is related, in turn, to patient safety problems and incidents and perceived errors. In addition, the representative of the young doctors warned that “working more hours than those allowed or those that are understood as healthy does not imply more learning.”
For his part, Álvaro Cerame, from the European Junior Doctors, a member of the board of directors of this institution, stated that resident doctors “are doctors, they can and should carry out care work; but, due to legal circumstances, they should not be the structural staff of the centers ». In addition, he added that they are “seeing that in some places they occupy a more structural role, and that is a problem.”
Improvement proposal
Based on the data shown in the report, the CGCOM national section of young doctors makes a series of recommendations with the aim of improving the conditions of training specialists, reducing the impact on their health and improve the quality of care for patients.
Thus, the data show the need to amend the specific legislation on the employment relationship of a special nature for residents so that it is in accordance with European regulations, while at the same time establishing mechanisms for the supervision of working conditions in the who work with doctors residing in Spain.
Within this review, the CGCOM requests that a maximum of four mandatory guards per month be established; modify RD 1146/2006 so that it includes the weekly rest (36 or 72 hours) present in the current legislation and whose violation has been made clear in the jurisprudence of the Supreme Court; implement control systems for possible excesses of the regulations and adjust training times to the acquisition of skills.
On the other hand, it considers essential the development of evaluation systems for specialized health training, through external audits by the Ministry of Health and satisfaction surveys by the Autonomous Communities, with special interest in the evaluation of the material learning conditions and the development of teaching management plans. Finally, it also advocates a review and improvement of the remuneration framework of the MIR so that the complementary shift through the guards does not represent the bulk of the salaries.
On the other hand, one of the key elements included in the study is the fact that, in order to enforce the European directive, training doctors cannot assume the number of working hours that they are currently doing. This is going to entail the review of different training programs in the specialty, causing training times to be modified, which is in line with what was proposed by the Council, where training in skills is advocated.
As revealed at a press conference, CGCOM presented the conclusions to the Ministry of Health and plans to transfer this report and its proposals to the Ombudsman, as well as to the European Parliament through a request to its Parliamentary Committee on Petitions. (PETI), among other actions. «Health has collected the information with great kindness. We see that the Ministry and politicians are concerned,” said the president of CGCOM, Tomás Cobo. Prior to this act with the media, they held a meeting with the health officials of the main political parties to explain this study and the corporation’s proposals in this situation.
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