Public health crisis: interim doctors fleeing to private practice

A 30-year-old doctor leaves the public system: 10 night shifts of 24 hours per month

How many 24-hour shifts can a specialist endure before quitting? In a region governed by the PP, a 30-year-old surgical specialist has left her interim post in a public hospital for the private sector. This is not an isolated case: in her specialty, there are unfilled vacancies in all hospitals in the region, forcing those who remain to work 9 or 10 monthly 24-hour shifts, plus travel days to district hospitals and afternoon administrative tasks.

The leak is not limited to the private sector. Some colleagues move to other regions with better working conditions, and other professionals, such as a nurse, have also changed destinations: they earn less but have better schedules and a better work environment. The result is always the same: the more the staff is depleted, the heavier the burden on those who stay.

What are localized shifts and how much are they paid?

Not all shifts require sleeping in the hospital. In localized shifts, the doctor is on call without being physically present, reachable by pager at any time. These are paid at about 200 euros daily. If called three or more times, it is paid as if the shift were in-person.

Can this be fixed with more residency spots and faculties?

Training offers are increasing, according to data from those involved in the debate: the number of residency spots has risen over the last ten years to exceed 8,600, with an increase of 1,500 spots in Medicine access expected in the coming years. Proponents argue that more trained residents increase the likelihood they stay, noting that public health is one of the few sectors where all spots are filled: with more supply, they would be covered equally.

Skepticism comes from another side. Training specialists does not guarantee retention: some renounce assigned posts, and others leave after one or two years of residency to retake exams and choose another specialty. And there are destinations no one moves to, regardless of salary. In Family Medicine, according to the debate, the Community of Madrid was the only territory where all spots were filled in the first round.

The public doctor's salary: good or bad depending on who compares?

Disagreement here is total. It is argued that Madrid's public health salaries are quite good compared to other sectors, and that in Castile, pay is higher, though the problem is not salary but destination: no one wants to work in villages, no matter the pay. Comparison with the broader labor market raises doubts: it is unusual for a university-level profession to endure such volume of shifts, and some mention offers outside Spain and the case of a cardiologist who stayed in the United States with a much higher contract as possible explanations for the exodus.

MUFACE: the door public servants already use to choose private care

The case of public servants adds a layer of irony. MUFACE is a public insurance system where one can choose a health entity, either the public system or a contracted private entity, with the same guaranteed service package in both cases. This leads to the recurring accusation that some abandon their own system. Those defending public health respond that Spanish private health is not an international reference hospital: it often works with the same doctors, with technology not always better, and its real advantage is the entry barrier of payment, which reduces care pressure. When cases become complex, it is the private specialist who sends the patient back to public health.

The same problem, with a British accent

This scene has precedent. In the UK, the public health service has years of staff shortages, with doctors on leave and health centers unable to accept new patients. It is argued that pogre dismantling seeks to make private business more attractive, a suspicion admitted by those who raise it and not backed by any evidence. The model is also debated: some argue that universal coverage systems funded by taxes are exposed to pressure from those accessing them without contributing, while contributory schemes, like the German or French models, would allow sustaining health without these holes. This is a debate no country has closed.

The balance, for now, is of an account that balances on the wrong side. Each specialist who leaves leaves a vacancy that goes unfilled and swells the waiting list of those who remain.