Hospital department heads threaten to fold if they cannot combine public and private healthcare

BarcelonaIn Catalonia there are many doctors who combine their work in the public and private health systems. The former combines knowledge, academia and patients with greater complexity, but salaries are lower than in private clinics. This means that many workers, when they finish their work day in the public sector, choose to work in private medicine to get an extra salary, especially in the specialties of dermatology, ophthalmology, surgery, cardiology and otorhinolaryngology. They are professionals who, they say, would earn a much better living if they had chosen only the private branch, but who have chosen the public system by vocation and complement it with two or three afternoons in a private clinic.

Now, the Ministry of Health wants to deploy New regulations on the working conditions of healthcare professionals, since it has not been updated for 22 years. Although the State hopes to present a "very advanced" text in April, negotiations with the unions are stuck for various reasons of conflict. And one of the aspects that raises the most controversy is the desire to demand exclusivity for positions of responsibility and management in public health so that they cannot work in the private sector. The measure will affect middle management such as heads of service and heads of section, and many of them have already positioned themselves against it.

"I don't think it's a good decision on the part of the administration. There is a general discontent and many colleagues will stop being heads of service if it ends up being approved," says Joan Fontdevila, who is president of the Spanish Society of Plastic, Reconstructive and Aesthetic Surgery and head of the plastic surgery and stress service. According to the ministry, professionals who are in charge of management and administration tasks must dedicate themselves exclusively to the public system and, to compensate for this, a financial supplement will be created.

But this extra does not make up for many heads of services who combine their work with the private sector. "It does not make sense. The remuneration should be in line with the responsibility, and it is not, it does not compensate," laments Fontdevila. In addition, these are positions that are renewed every four years and, if they do not meet the requirements, they are removed from responsibility. "It is not necessary to prohibit or limit what we do when our working day ends; if we do not do what we were supposed to do, we are removed from the position," he says.

According to the head of the surgery service of one of the most important hospitals in Catalonia, who wants to remain anonymous, many colleagues will leave their positions to continue to combine work in both systems. He only works three afternoons a week in the private sector and considers himself a "firm defender of the public system", but warns that he will leave if he is banned from combining it with private medicine. He also warns that this carries the risk that some workers will leave the public sector: "Private clinics are rubbing their hands. It may be easier for them to attract talent from the public sector."

Risk of desertion

Outside Catalonia, discontent is also growing. Jaume Estrada, head of the plastic surgery service at the Son Espases Hospital in Palma, explains that, since he completed his speciality, his dream was to work in a hospital and treat complex pathologies. He has spent his whole life performing reconstructive surgery and only goes to work in the private sector for two afternoons. Even so, he believes that, like him, the heads of service "will have no choice" but to give up their responsibility to continue combining both circuits. For this reason, Estrada ironically says that this framework statute "has the virtue of bringing the entire profession into agreement, regardless of the speciality, because there will be no one who wants it, since it will worsen the conditions of the professionals."

It must be said that some communities already have this exclusivity, such as Aragon, Asturias, Navarre or Andalusia, and according to Fontdevila, in some centres plastic surgery services have had to be closed because they were unable to find specialists. "In some hospitals there has been a real desertion of professionals," he maintains. Furthermore, if people with more experience and background do not want to be heads because they work in the private sector, the position will be taken by professionals who have been there for less time. "Being a head of service can become a transitional position for incoming doctors, until they gain momentum, are called from the private sector and give way to someone else," warns the surgeon.

This Tuesday, the Ministry of Health and the autonomous communities met to discuss the framework statute. The unions CSIF, FSES, CCOO, UGT and CIG Saude, which are participating in the negotiation table, have already warned that they will postpone all scheduled appointments until April while the head of Health, Mónica García, does not receive them "urgently." For his part, the Secretary of State for Health, Javier Padilla, has guaranteed them that the framework statute will "only" be discussed in the negotiation area. Sources from the Ministry of Health have ruled out taking a position.