Oriol Yuguero: We need a more honest distribution of doctors in Catalonia

LLEIDAA medicine graduate from the UdL with master's degrees in bioethics and public health, Oriol Yuguero (Lleida, 1984) has always been precocious. Not only because in 2021 he was awarded the ICS Young Researcher Prize, but because he founded the first Medical Students' Council in 2005, was a councillor at the Paeria in his early twenties, a general practitioner at 29, and at just 40 he became the director of Emergencies for the entire province, from where he drove the transformation of the service. Last summer, he was appointed manager of the two public hospitals in the city of Lleida after winning the first public call for applications held for this position.

What is your assessment of this position?

— My perception is very good. The hospital has experienced spectacular growth, also thanks to the drive of the previous manager with the increase in professionals. We are a very powerful hospital, with a large volume of activity, and this must be translated into resources. We only lack the final push in some strategic areas.

Which ones are they?

— Telemonitoring, because we are a very dispersed territory and there are patients who would not need to come to the hospital. We also have new projects in radiotherapy and oncology that we must promote. Especially the surgical block, which affects the rest of the hospital. We are defining a space plan to decide how we should grow over the next ten years.

How to grow?

— The solution would be to build a new building at the exit of the city, but we have a seventy-year-old building that we must maintain and we must grow around it. We have recovered the relationship with the City Council, which must help us with the spaces and to see where we can grow. We also have to reorder the mobility of the environment. The challenge is to consolidate the union of the Arnau and the Santa Maria as a single health park.

At what point are the construction works and the space plan?

— The works on the surgical block will be finished during 2028 and at that moment we will also have the new heliport. We are also building a new interventional area for bronchoscopies on the ground floor... Before the end of the year we must define the spaces we need in the coming times.

Does the alliance with Santa Maria also have to gain content?

— We must give shape to the strategic alliance and create healthcare structures that allow us to work together. Santa Maria has very strategic projects in dementia, cardiovascular risk prevention, and respiratory pathologies. These are projects that may have been overshadowed by the size of Arnau, but they must also be valued.

Are we at a key moment?

— Lleida is now on the map. Many people who previously had to go to be treated for emergencies in Barcelona can now do so here. We are reducing the risk, because ten minutes more or less are fundamental. We have the capacity and we have the volume. It is a very important moment to strategically place the hospital where it belongs. Because every life that we can save here in Lleida is worth the same as any other that is saved in Barcelona.

Does this territorial position also demand more resources?

— A hospital like ours is more expensive: doing things far from large centers requires more investment. But the people of Tremp and the Pyrenees have the same right to have their doctor. In Barcelona, many hospitals compete within a few kilometers; here the distances are different. The people of Lleida think twice before going to the emergency room, and we have a very high level of care complexity.

Is there an exodus of Catalan doctors?

— It is not that Catalan doctors are leaving: it is that there is a shortage everywhere. The conditions at the ICS are good, but people move. There is a lack of good distribution of professionals and, above all, an honest distribution. We must plan well how many we need and where. When we say that there is a shortage of doctors in Catalonia, we must ask ourselves if we are placing them where they are needed: in a neighborhood of the Eixample there are surely more doctors than in the entire Pyrenees.

The new generations no longer want to work long hours...

— The "Not one minute less" strike shows that we are working with the overexertion of professionals. Before, a single doctor would work two shifts; now the younger ones do not want to work morning and afternoon, and it is a social reality. I have nothing against young doctors: perhaps those of us who have been wrong are the older ones. When I finished my residency in 2013, almost my entire graduating class went unemployed. Ten years later, there was a shortage of doctors. Someone planned it poorly.

Does the healthcare system work?

— Our system in general is not prepared for social changes. People today want to take better care of their children and have a life of their own. They do not want to work twenty-four hours, because it is unbearable. We must rethink the system if we want it to be sustainable.

All the managers of the Arnau hospital have always been male. Is this position only for men?

— First I must say that I am the first ICS manager chosen in a public process. This had never happened before! And four candidates presented themselves... men. But watch out. The manager of Bellvitge is now a woman. The management at Joan XXIII in Tarragona, at Josep Trueta in Girona and in Tortosa are also in charge of women. Here in Lleida, perhaps the situation has not occurred yet. I presented myself with the desire to carry out a reorganization and in my current team the majority are women. The truth is, since there are more professional women working in medicine it is logical that they are in positions of representation.

So far, 26 million euros have been invested in the surgical block, 46 million in outpatient clinics, and only 1.5 million in obstetrics. Has there been a patriarchal perspective, until now?

— I, who have had my children in this hospital, believe that the previous space was degrading. I do not know if it was a patriarchal issue. Social and political pressure has meant that now we have a very good space, with individual and modern rooms. Now we must think about how we want the hospital to be in ten or fifteen years. We cannot carry out works just to get by and mortgage ourselves for another ten years: we have to talk with the departments and think about the whole.

You continue to work shifts, even though you are a manager. Why?

— Because I really like seeing patients, talking to them, and understanding them. My goal is not to go on chaining management positions: I am a doctor and I applied for the position somewhat pushed by the heads of service. I want to maintain contact with the care provided because it is important to know what is happening. I enjoy being in the emergency room and I believe that if you are a doctor you should not hide it. I am in this new position temporarily; I said I would be there for four years, six at most.

And the mayoralty of Lleida? Has he ever expressed that he would like to be mayor…

— I am not considering it in the medium term, nor am I talking about it. But I believe that being the hospital manager is already doing politics. 3,000 people pass through here every day! Apart from the technical side, the political part of management is very important: the relationship with institutions, the city, the university, research centers, and entities. We lack investment and perhaps we will have to create a foundation so that people in the territory can collaborate on projects for the city. Communication is important: when you explain why things need to be done, people understand. We must know how to explain that what we do here is also crucial.