Exactly 5 years ago, in the middle of the COVID-19 pandemic When the first vaccines had not yet been applied in our country, together with professors doctors Miguel Galmes and Gustavo Piantoni, we gave a speech to celebrate Doctor’s Day at the Argentine Medical Association (AMA). AMA is a famous institution of Argentine medicine. Founded in 1891 with a focus on higher education, it brings together the country’s scientific medical societies. On that Doctor’s Day, the great hall of the AMA was deserted and a painful ruin. We were just four colleagues on stage, but a large number of professionals were actually connected to the event. We have lived in an atmosphere of great uncertainty. The pandemic has exposed our fragility and the importance of the health team.
It may be illustrative to compare the situation For the doctor 5 years ago, although the current doctor includes new data. 5 years later, we still ask ourselves what is the commitment to doctors in society in general and the health system in particular. It is evidence shared by all colleagues that the hostile scenario towards doctors affects their daily work. Over time, I saw that doctors’ problems in professional practice not only persisted, but also deepened. A prominent group of Argentine doctors wrote down their thoughts 16 years ago in a book entitled Why be a doctor today? In the introduction, a quote from Jean-Paul Sartre stands out, which is certainly very poignant: “We are all responsible for what we do not try to avoid” (Libros del Zorzal, Bs. As. 2009).
doctors We have been ranked during the COVID-19 pandemic As “essential workers.” Society has reinforced the dimension of this “essential” by recognizing it, and this has been translated into the 9 p.m. applause. We already realized at the time that there was a good chance that this sympathy for doctors would be extinguished once the risks and fear of the pandemic disappeared. And so it happened. The return to normalcy has left doctors in the same position as before the pandemic. But it is unfortunate that we are returning to square one: a fragmented and inequitable health system, underpinned in many areas by a “doctor’s message” to resolve the multiple cracks in a system that everyone suggests is in chronic crisis and on the verge of collapse. In these five years following the epidemic, the three health subsystems in Argentina, public, social and private, resumed their hostile treatment towards doctors, which translated into undeserved income, in an inappropriate work scenario and even with frequent bouts of attacks by patients and family members towards the health team.
At the recent Argentine Cardiology Congress, the results were announced From a survey conducted by the Forum of Argentine Medical Associations, 64.5% of 2,920 doctors surveyed across the country admitted to experiencing signs and symptoms of the disease. Exhaustion (a state of physical and emotional depression) resulting from difficult or unsafe working conditions. Multiple jobs – as a result of low salaries – and “lack of a clear career horizon” have been cited as the main factors leading to this situation. Behind these data, alarming in themselves because of the risks involved in straying from minimum standards of quality and safety, the report revealed two shocking and disturbing data regarding the future of healthcare in our country: only 52% of the doctors surveyed answered that they would study medicine again, and 49.8% admitted that they had considered emigrating due to adverse working conditions.
Today we must acknowledge that there is a sign of hope: communities Scientific medical institutions have begun to harmonize their academic objectives, which were typical of their origins 100 years ago, and are now also focusing on the new reality of the professional work scenario and its multiple challenges. The survey mentioned above is an example of this change in perspective. Even this has not penetrated sufficiently into the medical community to achieve a critical mass of physician participation in their professional associations. The prevailing climate of the time, saturated with individualism and stigmatization of any semblance of solidarity, conspired such that in this scenario of intersecting interests, doctors were no longer the most fragile link in the chain.
It’s not good for society That their doctors are exhausted and do not have enough time to update themselves. It is not good to be treated by robotic or frustrating doctors. It is not good if the doctor does not have time to listen to the patient in 10-minute consultations. It is not good for society to have critical specialties that suffer from a noticeable shortage of specialists. Doctors decide not to devote themselves to clinical medicine, pediatrics, neonatology, or intensive care (among other specialties) simply because the relationship between effort, risk, and compensation is completely absurd. They also do not decide to settle in remote places because there is no health system to support them in this effort. This entire panorama remains unchanged.
The next question has not lost its validity: how is this possible That the approach to health issues suffers from the fluctuations of political administrations in power without a sustainable plan over time? We doctors have always expected others to solve problems in our professional field. We have encapsulated ourselves in our technical and academic subjects. The tree prevented us from seeing the forest without noticing the fire that was advancing from its surroundings. This deterioration seriously threatens the quality of work and erodes the careers of many.
It is essential that doctors, along with all professionals and actors in the health system, be active champions of the country’s health policies through Our institutions. The way to achieve this (already expressed in these pages) is to encourage the creation of a national health agency, that is, a decentralized state entity. All functioning health system institutions should integrate this agency through their representatives. This body will prepare projects and protocols in conjunction with ministries of health (national and regional).
There are many issues that require urgent decisionsFor example: that medical residencies be compulsory as the only training path to obtain qualifications to practice as a specialist; That these residencies are carried out in strictly accredited care centres; Determine the quotas of vacant positions in the residencies of each specialty according to the country’s needs; Stimulate training in critical specialties and set salaries and fees commensurate with the responsibility and preparation involved in health care. There are two important health-related issues that have emerged during these five years. One is the Health Quality and Safety Act (Act No. 27797, “Nicholas Law”), which was recently enacted. This law must be carefully structured so as not to leave gray areas for free interpretation. The presence of the National Health Agency would have provided the ideal environment to advise on this regulation. Today it is required to incorporate an advisory committee. Another disruptive event after the pandemic is the emergence of artificial intelligence with direct access to its generative version. A powerful new tool that wasn’t available 5 years ago. Its basic regulation for its application in medicine will be another central goal of the National Health Agency.
like conclusionIt is worth repeating: only through rational state health policies, which have been agreed upon with all actors in the three subsystems, and to which adherence can be guaranteed – regardless of political ups and downs – will we be able to leave our cyclical frustrations behind.
Consultant Professor in the Department of Ophthalmology, UBA Faculty of Medicine; Doctor of Medicine (UBA), Hospital de Clínicas (UBA)