The number of places for family doctors at the last resident doctors (MIR) call from the Spanish government is of 1,671, only 25% of all specialties convened. The question is: Will this annual promotion of family doctors cover the future needs of an increasingly aging population? If we’d pay attention to a report from British experts, "Securing the future GP workforce" the answer would be clearly negative. This document ensures that to meet the challenges in chronic disease from primary care, half of medical students who now graduate would need to become family doctors. But how to make the profession more attractive if its disrepute is so big that each year, at the MIR call, there are many vacancies left and the dropouts during training reach 15%?
In a survey (“Why doctors flee and shun the family medicine?” by Gonzalez B, Barber P and Ortún V) undertaken with students from the sixth grade of the medical course, a surprising finding stands out: students prefer generalist specialties, including family medicine. The surprise, however, doesn’t last long, because after strenuous preparation for the MIR test, most of, by now graduated doctors, shift in preference and opt for more technical specialties. The same survey warns that, this in this shift, we can detect not only the influence of MIR but also other relevant issues such as working conditions, pay and prestige.
The influence of training in medical schools
Students are receptive to the training received. In fact, the preference that they have for more general specialties over the MIR test, is given, according to the researchers, by heavily central curriculum. What a shame that, according to the latest data I have available, only 28% of Spanish medical schools offer family medicine as a subject, which means that about three quarters of schools waste their opportunity to nurture, from the formation stage, the students’ primary care vocations.
In an article from the British Medical Journal, "Fire the Medical Schools Council if you want more GPs", Richard Wakeford says that he reviewed the websites of 33 schools of public medicine in the UK, and found that only one, Brighton and Sussex Medical School, spoke openly of family medicine as a career opportunity. Given the rarity of the phenomenon, I present the video that certifies this:
The influence of working conditions
Medical students, well entrenched in hospital practice, have an image of primary care as a place where a bureaucratic medicine (recipes, registrations, reports, etc.) is carried out in a climate that is overwhelmed by patients of little clinical interest and especially with a lot of job insecurity and wages lower than those of the specialists, this latter aspect being confirmed by all the comparative studies, both here and in the UK.
The influence of professional prestige
With regards to the professional prestige, primary care always loses the game. This is a historical fact, although full of contradictions. But we’d better watch out, because right now an opportunity that should be exploited is emerging. Services integration programs for chronic patients should strengthen the image of the family doctor with regards to leadership and this should be perceived through multidisciplinary work and a supply adjusted to the needs of each individual service. Those patients realize that family doctors and specialists meet up to draw a plan for them, I think it's a new circumstance that should result in a family doctors’ prestige enhancement.
When society needs integrated care more than ever, we can not allow family medicine to sink and for this we need an (intensive) training strategy for medical schools, a resident doctors selection that is suitable for this strategy, facilitation for the integration of services and, above all, clear improvements in the working conditions of family doctors; not only in wages but also in prestige.