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Álvaro Soto
Madrid
Monday, 25 March 2024, 22:48
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Medicine is the only profession in which an employee in Spain can legally remain at work for 24 hours at a time with the approval of the administration. Full-day on-call duty was introduced into the Spanish healthcare system 50 years ago and has since become normalised, despite the obvious detriment that such long working hours cause to professionals and patients.
Health minister Mónica García announced last week a reform of the statute for health professionals to reduce 24-hour medical shifts to 17 hours, but the plan has been met with scepticism by medical groups and trade unions in the sector, who believe that the lack of financial and human resources could make it unfeasible.
The model, one of the causes of the huge spike in burnt-out worker syndrome among healthcare workers, has once again become the subject of debate after critical care doctor Tamara Contreras collected 120,000 signatures via Change.org to put an end to the 24-hour shifts. Contreras was received last Wednesday by the minister, who is an anaesthesiologist by training, and shared the petition with her.
These full-day shifts are "physically and mentally exhausting" and are leading healthcare workers to "want to leave the profession, change specialities or escape the system for something as basic as quality of life", she said.
In her post on Change.org, Contreras detailed real situations that occur in health centres every day and appeals to patients to understand. "You arrive at accident and emergency department. You are in a very serious condition and are admitted to the intensive care unit. A doctor has to make a life or death decision. Do you prefer a doctor who is clear-headed or one who hasn't slept for 20 hours?" Her appeal goes on to say, "This is the reality of our current healthcare system, which forces doctors to work 24-hour days, putting the lives of our patients at risk."
After meeting with Contreras, Monica Garcia showed her full support for the petition. "When we tell the outside world about it, people don't believe it. We have to put an end to this," said the minister, who pledged to reform the statute.
Complexity
"The ministry is fully committed to this, knowing that it is complex and that it requires a restructuring of our health system and a restructuring of our working hours," said García, who cited countries such as Sweden, which have already done away with the model. She added that it is about "reorganising, restructuring and better management of working and rest hours".
García also advocated "flexibility", favoured a "service by service" variation and acknowledged that "it will be difficult to change" the system after half a century. In principle health workers agree with the proposal. "The ultimate goal of reducing on-call duty is clinical safety, i.e. that the doctor is in the best physical and psychological condition to attend to a patient. It is a measure that will also allow for a better work-life balance," argues the president of the General Council of Medical Associations (CGCOM).
However, the head of finance and services of the State Confederation of Medical Unions (CESM), María José Campillo, pointed out that there are at least two factors that complicate the ministry's plans. The first is the lack of professionals, especially in small and medium-sized hospitals. "Who is going to do the shifts that are going to be left without doctors?" she asked.
And the second is that on-call shifts represent "up to 50 per cent of many doctors' salaries". She went on to say that the proposal was "pie in the sky" and that a "serious proposal" was needed. For now, García points to the possibility of giving doctors working on temporary contracts permanent ones and "progressively" studying the changes.
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