Family physicians and primary level pediatricians in the region of Madrid are preparing to go on strike on Monday, November 21. The health workers are fighting against problems that have burdened primary care services for a long time, including overload of work.
“All the time we are being told that primary care is the base of the health system. But the base is falling down, and no one seems to care”, says Elena Polentinos Castro, primary health care physician and member of the Society for Family and Community Medicine (semFYC).
The industrial action will take place only a week after hundreds of thousands of people took to the streets of Madrid demanding a better health system. Earlier, in October, more than 50,000 did the same. Yet the regional government, headed by Isabel Díaz Ayuso from the right-wing People’s Party, continues to deny that there is widespread support among the people for reforms that would make healthcare more accessible to everyone.
They are proven wrong by a growing people’s movement, including platforms like Marea Blanca. For more than 10 years, these groups have been campaigning against budget cuts in the private health system and the prioritization of the private sector.
Richest region, smallest investment in health
The protest on November 13 was organized by a coalition of community groups, trade unions, civil society organizations, and professional associations. As Polentinos explains, all of them have been struggling with a deteriorating health system for more than 20 years. After the COVID-19 pandemic exacerbated many of the pre-existing problems, people decided to stand up for a truly universal public health system.
Health workers had been warning about the dangers looming over the local health system for a long time, but it was the pandemic that drew more people to the issue. Looking at how things have changed with the onset of the COVID-19 pandemic, more and more people are feeling that their right to health is in danger.
“One of the problems that patients in Madrid are facing right now is long waiting times, even for the most basic procedures, even in primary care. Primary health care workers are forced to see up to 50 patients a day in the case of family doctors, and up to 40 children in the case of pediatricians,” says Elena Polentinos Castro.
For many, the workload is proving to be unbearable, pushing physicians to move to other regions of the country or to emigrate outside of Spain. Adding to that are the inadequate salaries in primary care. The combination of the two factors means that the region of Madrid is not able to employ the number of physicians it needs, despite being one of the richest regions in Spain.
“If you look at per capita health expenditure, Madrid has one of the lowest in Spain. And from the small regional health budget, a negligible sum goes towards primary care, around 10%,” says Polentinos.
In some of the most recent attempts to employ new doctors, the Madrid region was able to fill less than a third of the advertised vacancies. In June this year, the region put out a call for 197 physicians, and managed to sign on 59 of them. In May, it advertised 128 posts, and only 21 came on board.
“All the time, you can hear that there are no doctors, but that’s not completely true. The working conditions are so bad that they leave to other places,” adds Polentinos.
Zoom-based emergency services
People are feeling they have less access to health care than before, and a new plan by Isabel Díaz Ayuso could make their position even more vulnerable. The plan would reshape the system of emergency care outside of hospitals, basing it partly on telemedicine.
In the first phases of the pandemic, staff from existing emergency outposts was temporarily reassigned to other health centers to better accommodate COVID-19 needs. This was done in order to make the most of existing health workforce resources. But when the time came to go back to normal, the regional administration announced that fewer outposts would continue to work then before. Instead, some of them would provide medical advice long-distance.
Physicians and nurses are refusing to work this way, fearing it could cause harm to patients.
“You can’t provide actual emergency care through videoconference. You have to be there with the patient to observe them. And what if they live in a place where the first hospital is one hour away? How are you supposed to make sure they are taken care of until they reach there, if you’re talking to them on Zoom?” asks Elena Polentinos Castro.
Prioritizing public health services as crisis approaches
In other parts of the health system, for example in hospitals, the budget is a bit bigger, but they are struggling with the effects of privatization. Many hospitals in Madrid are either private or public-private partnerships, which makes access difficult for people who cannot afford to pay for care.
At the same time, privatization has bled the public health system for millions. This again puts rural and poor communities at more risk. “These are the communities who rely most on the public system. They can’t go to the private sector. Without investment in public health care at a time when they are also exposed to the effects of rising costs of living and food, what should they do if they fall sick?” asks Polentinos.
The problems facing the health system in Madrid cannot be solved overnight. “But we should be talking about them, we should be getting ready for what lies ahead. This is the time when everyone should stand together to demand universal health care and equity. Nothing else will do the trick,” concludes Elena Polentinos Castro.