Ana Roca: "If a patient needs to be seen for half an hour, the system forces the doctor to see him in five minutes."

BarcelonaPediatrician Ana Roca (Torrelles de Llobregat, 1963) is the new president of Doctors of Catalonia (MC), the country's main medical union. The current vice president is the first woman to hold the presidency of the organization in its 125-year history. In a conversation with ARA, she reviews the main challenges facing the healthcare system and evaluates the actions of the Department of Health and the Ministry of Health.

How did you experience becoming president?

— I'm very happy and excited. The union has been working on equality plans for years, but until now it has never had a female president, even though more than half of the members and delegates are women.

How do you see the health system?

— The situation is very worrying. There are significant shortcomings in planning and very serious shortcomings in execution. Olga Pané will soon be a year in office as Minister of Health, and we have the feeling that she doesn't want to listen to the professionals. We've met several times, but we're making no progress. For now, the systemic transformation they were supposed to promote only affects primary care, but measures for hospitals to reduce waiting lists are nowhere near, and are not expected.

Salut has said that will present them in October.

— We'll see. For now, all the measures of the Committee for Evaluation, Innovation, and Operational Reform of the Health System (CAIROS) affect primary care centers, and many of them were already in place. We've had the goal of allowing doctors to serve a larger population by expanding their work schedule for five years. Furthermore, we've been talking about reducing bureaucracy for two decades, freeing doctors from all the paperwork and having other professionals take on the responsibility, but some of these tasks can only be performed by a physician. They talk about reducing bureaucracy as if it were the solution to all problems, but that's not the case.

They are testing artificial intelligence tools to reduce this bureaucratic work.

— Yes, they've incorporated this technology into consultations so it can record and transcribe the conversation between the doctor and the patient and add it to the medical record. Sometimes these conversations are very long, forcing the doctor to review and summarize the text once the patient leaves the office, otherwise, the medical records will become unmanageable and unreadable documents that cannot be worked on.

Another new feature is that professionals will have greater autonomy to organize and care for patients.

— This is also not true. Doctors have a number of patients assigned to treat, and that number is increasing all the time. In addition, there are absences and positions that have not been filled, in the case of professionals who leave the public system or are on sick leave, for example. This leads to overloads and the burnout of workers increase, and no matter how much flexibility they have in organizing themselves, they can't dedicate more than 3 or 4 minutes to each patient. This is unacceptable.

According to Salut, many CAPs applied for the pilot test to become comprehensive reference health centers (CSIR).

— We know there are many primary care teams that didn't want to participate, and they've been chosen. They have enough work to do without adding more. Many workers voted against participating in this pilot, which carries out an outdated analysis of reality and proposes measures that are already obsolete. They need to plan ahead, and not recycle measures that were proposed 20 years ago, because Catalan society has changed a lot in that time.

Do you think they will achieve a separate statute just for doctors?

— It's very difficult. We created the Professional Association for a Medical and Physician Statute (APEMYF) as a tool to lobby the Ministry of Health, which is working on a new framework statute for the healthcare sector. It produced a very poor draft, one that was very unfavorable to the interests of physicians, and we joined forces to achieve a medical statute. It's an ambitious proposal; we have the potential, but it's very difficult. Furthermore, it takes political courage to make changes, and this document, which the Spanish government is working on, could easily be shelved.

Can the health system afford a political climate in which it is difficult to reach agreements?

— Not at all. It works now because we professionals have a strong calling and prioritize serving the public. Those who save the system are the professionals, but this isn't infinite, and I see a lot of hesitation among the new generations. They're young people who have studied for many years, completed a very tough residency, and who don't want to work the way they do now. If a patient needs to be given a half-hour, we should be able to do it, but now the system requires them to see patients in five minutes. And on top of that, there's the pressure to be decisive, to ensure the patient doesn't return, to ensure they don't request too many tests, to ensure they don't have to see other specialists, and to ensure care is provided with the lowest possible pharmaceutical costs. It's a dramatic situation; we need 300 more professionals in primary care alone.

Salut will tell you that this year they have been covered the vast majority of family and community medicine positions.

— We'll have to see how many resignations there will be in the coming months. And, of those who complete their residency, we'll see how many will stay and work here in Catalonia. It's very likely that many of them will return to their country or go to another part of Spain where the working and professional conditions are better than here. In 2022, for example, of all those who completed their residency at a Primary Care Center (PCC) of the ICS (Institute of Social Security), only 49% stayed. They either left Catalonia or went to private insurance, because citizens are increasingly taking out private insurance; it's very sad. They are decapitalizing public healthcare, and this will end up leading to less funding for the system and more profits for private healthcare.