Patricia Barber

Forecasting the need for medical specialists in Spain: application of a system dynamics model

BackgroundSpain has gone from a surplus to a shortage of medical doctors in very few years. Medium and long-term planning for health professionals has become a high priority for health authorities.MethodsWe created a supply and demand/need simulation model for 43 medical specialties using system dynamics. The model includes demographic, education and labour market variables. Several scenarios were defined. Variables controllable by health planners can be set as parameters to simulate different scenarios. The model calculates the supply and the deficit or surplus. Experts set the ratio of specialists needed per 1000 inhabitants with a Delphi method.ResultsIn the scenario of the baseline model with moderate population growth, the deficit of medical specialists will grow from 2% at present (2800 specialists) to 14.3% in 2025 (almost 21 000). The specialties with the greatest medium-term shortages are Anesthesiology, Orthopedic and Traumatic Surgery, Pediatric Surgery, Plastic Aesthetic and Reparatory Surgery, Family and Community Medicine, Pediatrics, Radiology, and Urology.ConclusionsThe model suggests the need to increase the number of students admitted to medical school. Training itineraries should be redesigned to facilitate mobility among specialties. In the meantime, the need to make more flexible the supply in the short term is being filled by the immigration of physicians from new members of the European Union and from Latin America.

Factores predictores del inicio y consolidación del consumo de tabaco en adolescentes

Objetivo: Analizar los factores que determinan la adquisicion y posterior consolidacion del consumo de tabaco en los jovenes adolescentes. Material y metodo: Estudio longitudinal de 3 anos de duracion (2000-2002) sobre jovenes estudiantes de ensenanza obligatoria, con una edad al inicio del estudio de 13-14 anos. Los datos fueron recogidos mediante encuesta individual, cuyo ambito de estudio era la isla de Gran Canaria, con una muestra final de 745 individuos. Se estimaron modelos de eleccion binaria condicional de efectos fijos para datos longitudinales, para determinar la probabilidad de probar por primera vez el tabaco («modelo de inicio»), asi como sobre la probabilidad de ser fumador ocasional o habitual («modelo de experimentacion»). Resultados: En el ultimo ano, el 57% de los adolescentes encuestados ha tenido contacto con el tabaco alguna vez, un 25% mas que en el primer ano, algunos de ellos (el 9%) de forma diaria. En el «modelo de inicio» los determinantes del consumo de tabaco son el interes por el colegio (odds ratio [OR] = 0,27; intervalo de confianza [IC] del 95%, 0,08-0,87, y OR = 0,14; IC del 95%, 0,03-0,58 para los que manifestaron bastante y mucho interes por el colegio, respectivamente), el consumo de tabaco por parte del mejor amigo (OR = 7,44; IC del 95%, 2,59-21,4), el consumo de alcohol (OR = 11,82; IC del 95%, 4,96-28,2, y OR = 15,42; IC del 95%, 4,68-50,7 para los que beben alcohol de manera ocasional o frecuente, respectivamente), y el dinero disponible (euros semanales) (OR = 1,13; IC del 95%, 1,07-1,19). Para el «modelo de experimentacion», el consumo de tabaco por parte del mejor amigo (OR = 7,01; IC del 95%, 2,96-16,5), el consumo de alcohol (OR = 5,71; IC del 95%, 1,98-16,4, y OR = 5,22; IC del 95%, 1,56-17,5 para los que beben alcohol de manera ocasional o frecuente, respectivamente) y los anos que lleva como fumador (OR = 1,44; IC del 95%, 1,11-1,86). Conclusiones: El estudio destaca, principalmente, los efectos del grupo de amigos, el consumo de bebidas alcoholicas y el poco interes por los estudios como factores asociados al consumo de tabaco.

Specialty choice in times of economic crisis: a cross-sectional survey of Spanish medical students

Objective To investigate the determinants of specialty choice among graduating medical students in Spain, a country that entered into a severe, ongoing economic crisis in 2008. Setting Since 2008, the percentage of Spanish medical school graduates electing Family and Community Medicine (FCM) has experienced a reversal after more than a decade of decline. Design A nationwide cross-sectional survey conducted online in April 2011. Participants We invited all students in their final year before graduation from each of Spains 27 public and private medical schools to participate. Main outcome measures Respondents’ preferred specialty in relation to their perceptions of: (1) the probability of obtaining employment; (2) lifestyle and work hours; (3) recognition by patients; (4) prestige among colleagues; (5) opportunity for professional development; (6) annual remuneration and (7) the proportion of the physicians compensation from private practice. Results 978 medical students (25% of the nationwide population of students in their final year) participated. Perceived job availability had the largest impact on specialty preference. Each 10% increment in the probability of obtaining employment increased the odds of preferring a specialty by 33.7% (95% CI 27.2% to 40.5%). Job availability was four times as important as compensation from private practice in determining specialty choice (95% CI 1.7 to 6.8). We observed considerable heterogeneity in the influence of lifestyle and work hours, with students who preferred such specialties as Cardiovascular Surgery and Obstetrics and Gynaecology valuing longer rather than shorter workdays. Conclusions In the midst of an ongoing economic crisis, job availability has assumed critical importance as a determinant of specialty preference among Spanish medical students. In view of the shortage of practitioners of FCM, public policies that take advantage of the enhanced perceived job availability of FCM may help steer medical school graduates into this specialty.

Young Adolescents, Tobacco Advertising, and Smoking.

Background: In adolescents aged 12–14, we measured attitudes to tobacco advertising. Our purpose is to understand the relation of these attitudes to tobacco use and identify the groups most influenced by the advertising. Methods: Survey of adolescents on Gran Canaria Island, Spain, about aspects of family, school, peers, tobacco consumption, and tobacco advertising. The subjects of the double-stratified cluster sample were 1910 students at the same grade level in 33 schools; 86.6% were 13 or 14 years old, and 51.2% were boys. We generated measures for attitudes to tobacco advertising from replies to seven questions with ordinal scales by an analysis of categorical principal components. To relate attitude to tobacco advertising and the profiles of these adolescents, we used multiple regression and logistic regression models. Results: Attitudes to tobacco advertising are related to some home and school factors, but most significantly to tobacco and alcohol consumption, to amount of time at home without adults, and to peer influence. Conclusions: It is possible to draw up profiles of the students most vulnerable to tobacco advertising, and to cluster them in two groups, the “vitalists” and the “credulous.” The effect of cigarette ads is different between these groups. This study can help to orientate smoking prevention.

Attitudes of Teenagers Towards Cigarettes and Smoking Initiation

This paper contributes to the empirical knowledge of determinants of smoking initiation in adolescents. The instrument we used was a structural equation model, which is a powerful tool to analyze causal relationships in nonexperimental studies. We used a school-based sample of 1198 teenagers from Spain. We measured the attitude of the adolescents towards tobacco. Attitudes and smoking status are related. Attitudes become more favorable to smoking, as experimentation with cigarettes progresses and pupils become older. Teenagers who have tried at least one cigarette are on average more favorable to smoking than those who had never smoked. The studys limitations were noted.

Real waiting times for surgery: proposal for an improved system for their management

OBJECTIVES In Spain, official information on waiting times for surgery is based on the interval between the indication for surgery and its performance. We aimed to estimate total waiting times for surgical procedures, including outpatient visits and diagnostic tests prior to surgery. In addition, we propose an alternative system to manage total waiting times that reduces variability and maximum waiting times without increasing the use of health care resources. This system is illustrated by three surgical procedures: cholecystectomy, carpal tunnel release and inguinal/femoral hernia repair. METHODS Using data from two Autonomous Communities, we adjusted, through simulation, a theoretical distribution of the total waiting time assuming independence of the waiting times of each stage of the clinical procedure. We show an alternative system in which the waiting time for the second consultation is established according to the time previously waited for the first consultation. RESULTS Average total waiting times for cholecystectomy, carpal tunnel release and inguinal/femoral hernia repair were 331, 355 and 137 days, respectively (official data are 83, 68 and 73 days, respectively). Using different negative correlations between waiting times for subsequent consultations would reduce maximum waiting times by between 2% and 15% and substantially reduce heterogeneity among patients, without generating higher resource use. CONCLUSION Total waiting times are between two and five times higher than those officially published. The relationship between the waiting times at each stage of the medical procedure may be used to decrease variability and maximum waiting times.

El baremo académico en el acceso a la formación médica especializada en España

espanolIntroduccion. La seleccion en la formacion sanitaria especializada de los medicos (MIR) se basa en la equidad interpersonal que premia a los candidatos segun su esfuerzo. El rendimiento academico, a traves del baremo, refleja el ‘esfuerzo de fondo’, mientras que el examen MIR mide el ‘esfuerzo sprint’ . Este articulo discute los pros y los contras de mantener el baremo academico, que actualmente pesa un 10%. Por un lado, mide capacidades y habilidades mas alla del mero conocimiento que aporta el examen; pero, por otro, puede tener problemas de validez, no modificar elecciones debido a su bajo peso o no ser coste-efectivo. Materiales y metodos. Registro de adjudicatarios de plazas MIR 2012-2013 (Ministerio de Sanidad, Servicios Sociales e Igualdad) y encuesta propia a los MIR-1 2012-2013. Modelo multinivel para estimar el efecto universidad en el baremo academico de los candidatos. Resultados. Hay diferencias sistematicas en el baremo de los candidatos atribuibles a la universidad de procedencia cuando se comparan todas las universidades, espanolas y extranjeras (correlacion intragrupo: 47%), pero no hay diferencias significativas entre universidades espanolas (correlacion intragrupo: 7%). El 62% de los candidatos sube o baja menos de cien puestos en el ranking. Al menos el 1% de los candidatos cambiaria su especialidad elegida si se suprimiera el baremo academico, lo que supone un coste maximo de 576 euros por cambio. Conclusiones. El baremo academico es valido para las universidades espanolas, pero no para las extranjeras. Su supresion modificaria marginalmente el orden de eleccion y las asignaciones MIR. EnglishIntroduction. The selection on specialized health training of doctors (MIR) is based on interpersonal fairness that rewards candidates by effort. Academic achievement, through the average grade, reflects the long-distance race, while the MIR test measures the sprint effort. This article discusses the pros and cons of maintaining the academic grade, that currently weighs 10%. On the one hand, it measures skills and abilities beyond the mere knowledge that provides the test, but on the other, it may have problems of validity, it could not change elections, given their low weight, and/or it could be not cost-effective. Materials and methods. Database of MIR 2012-2013 (Ministry of Health, Social Services and Equality ) and own survey of MIR-1 2012-2013. We used a multilevel model to estimate the effect of the university on the candidate’s academic grade. Results. There are systematic differences in the grades of the candidates attributable to the university when all universities, Spanish and foreign are compared (intragroup correlation: 47%). There are no significant differences between Spanish universities (intragroup correlation: 7%). 62% of the candidates move less than a hundred places in the ranking if the academic grade would be suppressed, and at least 1 % of the candidates would change their chosen specialty. It represents a maximum cost of 576 euros per change. Conclusions. The academic grade is valid for the Spanish universities but not for foreign universities. Its suppression would marginally alter the order of choice and MIR assignments.