From leading during COVID to failing to fill its seats: What's happening with preventive medicine and public health?

Preventive medicine and public health were among the specialties at the forefront of the COVID-19 pandemic. Despite this undeniable prominence during one of the worst health situations experienced in Spain in the last century, subsequent years do not reflect the relevance they once had . An example of this is that last year, in the regular allocation of Resident Medical Intern (MIR) positions , the quota was not filled , leaving 12 vacancies, which were then filled in an extraordinary second round.

The allocation of MIR places begins this Monday, a process that will last 16 business days. Inmaculada Salcedo , head of the Preventive Medicine and Public Health Service at the Reina Sofía Hospital (Córdoba), analyzes how we got to this situation and what lies behind this paradox. "It's striking that the importance of public health and prevention during the pandemic has been demonstrated, and yet we've suddenly forgotten it," she laments.

This specialist asserts that one of the reasons lies in the foundation, in how and who teaches preventive medicine and public health in the medical degree. "In both primary and hospital care, preventive medicine and public health are fundamental , and what is taught there is not taught at universities, unless we are the specialists who teach the classes. The paradox is that they can be taught by a biologist or anyone who is trained in the subject . This is already a significant handicap at the undergraduate level because they don't know the subject," she complains.

The second point focuses on salaries because, he says, as an assistant, specialists can have lower salaries than their colleagues in other specialties. This is explained by the different models, which means they can have 12- or 24-hour shifts , or even none at all. Each hospital or health center has a preventive epidemiologist, who is usually organized in a different way, and, in his opinion, should be unified to ensure fairness with the rest. "It is unacceptable that a specialist with a resident status in preventive medicine and public health earns less than one in labor, surgery, internal medicine, or family medicine."

Hospital rotations and housing prices

Another issue to consider is the rotations , which, in his opinion, should offer the option of teleworking or online work . This would make it simpler and would prevent residents from having to search for an apartment in a city for three months , "given the current housing situation ." This is especially true in municipalities with " very good hospitals , but extremely expensive rent."

The last point concerns scientific societies, with their particular interests. Here, he criticizes some that handle a lot of money and interfere in the services portfolio of their specialty, "trying to take over areas that are our responsibility."

"Between the lowest salaries, the most expensive housing, limited access, in some cases, to teaching and research because it's dominated by other professionals who aren't specialists in the field... all of this is measured by the residents and they see the losses," he maintains.

"It's essential for students to rotate through hospitals and health centers because it gives them a sense of what the specialty entails."

Despite all these areas of improvement, Salcedo notes "with satisfaction" that many students want to rotate with them and assure them that in half an hour on the service, they have learned more preventive measures than ever before.

" Very few people abandon the specialty. That is, when someone takes it up, sometimes without much knowledge, it's very difficult for them to leave because it's so interesting and offers many career opportunities. But the fact that students rotate through hospitals and health centers is essential because it gives them a sense of what it's all about," he adds.

With this specialty, these doctors can work in a variety of settings: primary care, alongside their family medicine colleagues , hospital care, regional care, and nursing homes. Furthermore, they cover a large number of people, not patients, but " it's a quiet thing that doesn't sell or make headlines ." Beyond the variety of work locations, he also highlights the diversity of tasks, which means "you'll never get bored" and allows for "a great deal of creative and innovative capacity."

" Public health is not just public healthcare . We work to ensure that citizens do not have to resort to the healthcare system. Housing, healthy lifestyle habits, preventing smoking and alcoholism... all of this is public health. These are measures that, together with family medicine specialists , we are working on because they prevent diseases that prevent citizens from becoming patients , which saves the system costs and improves the quality of life," he concludes.