The 24-hour medical guards are “anachronistic” and the purpose of the Ministry of Health is to regulate them to put an end to them throughout this legislature.
This intention, expressed over the weekend by the head of the portfolio, Mónica García, responds to a demand that many professionals—and she herself—have been demanding for years.
But the guards are part of the machinery of hospitals and an important portion of the salary of many doctors.
Ending them, in the best of cases, is “very complicated” and requires a large amount of resources, according to medical unions and experts consulted by this newspaper.
There are good arguments for looking at other systems.
In a society that aspires to work fewer hours to balance work and personal life, doctors who work on call exceed 50 hours of work per week;
It has been proven that after continuous hours of work and lack of sleep, more errors are made, which can harm the patient, but also the doctors themselves, who multiply by 2.3 the chances of suffering a traffic accident when they leave work. after 24 hours straight, according to one study.
A good number of doctors are organizing to abolish this system, under the slogan “We can't take it anymore.”
More than 82,000 signatures have been collected on the Change.org platform.
This is how Tamara Contreras, a specialist in Intensive Care Medicine and promoter of the initiative, explains the situation: “You are very serious and they admit you to the ICU.
A doctor now has to make a decision that will mean you live or die.
Do you prefer a clear-headed doctor or one who hasn't slept for 20 hours?”
24-hour shifts are an anachronism that puts the rest, conciliation and mental health of our healthcare professionals at risk.
We will give you an answer this term.
— Mónica García (@Monica_Garcia_G) February 26, 2024
Contreras gives the following example: “Last night, the hospital pager rang at three in the morning, my legs were shaking from fatigue and stress.
A multiple-traumatized 21-year-old boy was bleeding to death.
Five minutes before he was dreaming I don't remember what, and suddenly I was channeling him to transfuse him with blood and intubating him to prevent cardiac arrest.
At seven in the morning we managed to stabilize him.”
A survey by the State Confederation of Medical Unions in 2022 showed that 87% of doctors perform on-call, although almost 60% of them would prefer not to do so.
Although from the age of 55 they are volunteers, 70% continue, probably because more than a third of the salary may depend on them, according to calculations by the CSIF union.
And this, despite the fact that “they are very poorly paid,” according to Víctor Pedrera, from the State Confederation of Medical Unions (CESM).
The remuneration for associate doctors on a normal day is between 20 and 30 euros gross per hour, depending on the autonomous community, which remains at just over half after taxes.
“They are overtime that is paid below what it should be because the on-call was supposed to be a way to have the doctor located due to an expectation of care.
But reality shows that for many specialties, it is not an expectation, but rather continuous attention,” he points out.
Pedrera believes that the minister's intentions are good, but that they would have to be accompanied by a "radical increase" in investment to "improve" the salaries of doctors, which "may seem high, but a good part of it is due to the guards." ”.
The opposite, in the opinion of José Frías, from CSIF, could be counterproductive: “We are short of doctors, especially in primary school, on many occasions because they leave in search of better conditions, and this can increase this shortage if there is a drop of salaries.”
The other problem encountered with the elimination of guards is organization.
“A huge increase in staff would be needed,” both union members agree.
“Health care is necessary 24 hours a day and if you eliminate the guards you will have to hire professionals to cover those shifts,” says Frías, who considers the proposal “idyllic” but “very complicated, if not impossible.” .
Tomás Cobo, president of the Collegiate Medical Organization, believes that to complete this change, a study would first have to be carried out to evaluate the needs according to the specialties and according to the services in each hospital.
Because not all of them do guard duty and, among those who do, not all of them have the same intensity.
“You have to see the incidents that exist in each service, check how the local guards are working and make a diagnosis of all this to see how it can be addressed,” says Cobo.
The president of the doctors knows well what he is talking about: like the minister, he is an anesthetist, one of the specialties that must be covered 24 hours a day.
“In this profession you also have to know that you cannot have a few hours stuck;
“If you are in the middle of an operation, you cannot leave, you cannot take shifts, as for example the nursing staff does,” she points out.
With these caveats, Cobo admits that it also makes no sense for a surgeon to perform a 12-hour operation and then engage in another that will last the same: “It is not logical for professional drivers to have a tachograph because they have to rest every X hours. and that we can be 24 in a row.”
12 hour guards
There are intermediate alternatives, such as the 12 hours that the United Kingdom has implemented for a long time and that others such as France or Iceland have adopted.
Others, such as Portugal and Germany, maintain a system similar to the Spanish one.
Sergio García Vicente, from the Health Economics Association (AES), believes that these 12 hours could be a solution, but that for this it would be necessary to restructure the staff and, for that, a study of the needs of each service, as Cobo proposed, analyzing whether all the doctors who are on call are necessary to provide continuous care 24 hours a day, seven days a week.
“It is impossible to remove the guards with the personnel there are;
“You cannot make a decree to suppress them without first taking all this into account,” he points out.
In cases where it is possible, the experience of fragmenting shifts to a maximum of 12 hours “works”, defends García de Vicente, “even attracting talents and women, since it allows a minimum level of personal and family conciliation. If that's the case".
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