“Quo vadis” Family and Community Medicine?

Another sign that Family and Community Medicine, the medical specialty most relevant to citizens and the health system, is in crisis: yesterday, the sixth day of the allocation of MIR places, 21 specialties exhausted their entire offer while Family Medicine, which started with 2,492 seats, Still not assigned 2.250.

The reasons why this specialty is essential for the life expectancy of the population and the sustainability of the health system, which should therefore be valued, respected, cared for and protected, are well known, Wither For years without there being a cure, or at least a stop, despite the constant chatter of the electoral programs of political parties in favor of its empowerment.

Who would have thought in the 80s when it was bigger and better Health reform Democratic Spain: Transforming old outpatient clinics, with their quotas and district doctors working for two and a half hours, into modern primary care, with full-time specialists, Multidisciplinary teamworkClinical history, integration of therapeutic activities with health promotion and prevention activities, etc.

The theoretical and legal model (Royal Decree No. 137/84 on Basic Health Structures and Public Health Law No. 14/1986), which unfortunately was not fully implemented, nevertheless left an unbeatable first level of care in many aspects.

And from there, Lack of funding and chronic shortage of human and technical resourcesThe error of not providing the general practitioner with greater capacity to solve (frequent and rare health problems) and coordination (to ensure continuity of care) and the absence of ambitious and far-reaching decisions in organization and management gave rise to the panorama stream. .

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It is curious that the transfer of health responsibilities from Insalud to the various autonomous communities, which was a very slow process (20 years; from 1981 with the transfer to Catalonia to 2001, with the transfer to the last 10 regions), although all the reforms were carried out While Royal Decree No. 137/84 was adapted to its judicial framework, it did not prevent the problem of primary care from being practically the same throughout the national health system.

Family medicine, despite its importance, is a Deficiency specialtyTherefore measures (improvement of salaries and working conditions, self-management of agendas, removal of bureaucracy, decision-making and coordination capacity of the system, research, etc.) are urgently needed to regain the attractiveness it had after the first system reform. Standard of care, which is an essential part of it.

The World Health Organization highlights, among other aspects, that: “Primary health care consists essentially of caring for people and helping them to improve their health or maintain their well-being, rather than being limited to treating a single disease or condition.” A health system with strong primary health care contributes to this Better health outcomes“It is cost-effective and improves the quality of care.”

But despite all this, the core medical specialty of primary care is mired in a crisis that seems to have no end. “Quo vadis” (Where are you going?) Family and Community Medicine?

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