Heat stress, COVID, or reactions to bites: Who will treat you this summer if there aren't enough doctors?

The shortage of physicians in Primary Care (PC) is not a new problem in Spain. Specifically, the Report on the Need for Specialists in Spain 2023-2035 estimates that there was a shortage of 5,874 specialists in 2023 , 76% of them (4,502) in PC.

This issue becomes even more acute in the summer . For Lorenzo Armenteros , spokesperson for the Spanish Society of General and Family Physicians , this process is "progressive": " There is no generational change , and the specialty positions do not meet the demand of those leaving."

"This has already been reported by all sectors and medical societies , and no solution has been found. Furthermore, in the summer, with all healthcare personnel on vacation, there is a noticeable shortage, which forces us to double the number of doctors we keep on during the summer, and consultations are delayed," he tells this newspaper.

For its part, the Medical Profession Forum , to which the Medical Association belongs, among others, indicates that the structural shortage of professionals "cannot and should not be compensated" at the cost of "care overload" and the renunciation of the right to rest for doctors: "As with the rest of the workers, it is necessary to preserve physical and mental health , an essential condition to be able to adequately care for patients. Alleviating these deficiencies by increasing the number of on-call shifts or forcing unlimited work schedules is not only not the solution, but will contribute to aggravating the problem."

Regarding the number of patients he sees on a summer clinic compared to a regular clinic , Armenteros admits that it's "the same or more." " Between 40 and 50 because we see our own patients and those of other colleagues who are enjoying their vacations," he adds. He also notes that this shortage of doctors also means there are no substitutes or they work shorter, overtime hours : " It's not a complete support for the health center."

Summer diseases

Another aspect the professional highlights is typical summer illnesses . "Foodborne illnesses are very common, as are some enteric viruses [those that primarily affect the gastrointestinal tract and are transmitted via the fecal-oral route]," he says.

Although he admits that for a few years now they've been seeing an emerging pathology "worthy of note ": heat stress . This is a heat load that the body accumulates under extreme conditions, such as heat waves. " Children, pregnant women, the elderly , and patients on chronic treatments have a distortion in their thermoregulatory system and can experience acute consequences , such as heat stroke and other ailments that generate a large number of consultations. It produces a feeling of nonspecific discomfort; they feel tired and dizzy due to excessive heat and dehydration," he continues.

He goes on to say that increased vigilance is needed for patients with diabetes , hypertension, or circulatory disorders in the summer: "The consequences can be serious. The heat arrives early, and much higher temperatures persist in places we're not used to."

These aren't the only ailments he mentions; another one has also increased. "What a few years ago was a simple insect bite is now a very intense reaction. They come from a multitude of insects that in many cases we don't recognize, a consequence of globalization and imported species. This increases the possibility of infection and the development of, for example, cellulitis ," he says.

How overload affects

Regarding how healthcare overload affects physicians, Armenteros asserts that "they have become resilient" to the administration's "distortions," and that's why "the system survives." "We're doing poorly; the effort is compensated because you sacrifice so others can go on vacation, and then they do the same for you. If it weren't for that, it would be impossible," he insists.

He also explains that some health centers don't even have enough staff available for the summer vacation period. "A minimum number of staff members have to stay, so someone would cover for them, and that creates discomfort, combined with workload and fatigue . On-call shifts are doubled, and in many cases, breaks are skipped. Primary care is perhaps the level of care that feels the summer hardest, and that leads to less time spent with patients," he explains.

Necessary changes

He also cites the changes needed to address this problem: " Scaling up Primary Care and eliminating bureaucratic consultations, such as sick leave , or what I call hospital management, such as explaining blood tests, X-rays , or providing pathology results. These are incomplete processes on the part of the hospital and must be completed by the family doctor."

Finally, he emphasizes that there is no "real" political will to resolve this problem. "No autonomous community has even come close to meeting one of the basic elements: a tight budget . Hospitals always take up almost the entire budget , and primary care is always the poor brother . Healthcare should be kept out of politics; a global health pact would be necessary to take truly effective measures," he concludes.

However, the shortage of professionals will also be felt in the hospital setting . According to data from the Nursing Union (SATSE), Andalusia will close at least 2,200 beds ; Madrid, 1,539 (with information from eight hospitals); Catalonia, 1,300; the Valencian Community, 910; Aragon and Galicia, 700 beds each; and the Basque Country, 619.

In Extremadura, 500 beds are expected to be discontinued; Castilla-La Mancha , 373; Asturias, 370; Murcia, 317; Castilla y León will have 250 fewer beds; Cantabria, 164; Navarre, 146 fewer beds will be available; the Balearic Islands will close 116; and La Rioja, 54. In the Canary Islands and Ceuta, "no closures are planned."