The doctor in Mexico; his day and his reality

On October 23, the day of the doctor was celebrated in Mexico, but few people know the origin and significance of it. Perhaps for this reason, in addition to the politicization of the health system that occurs in Mexico, it passed without much recognition.

In 1937, during the presidency of General Lázaro Cárdenas del Río, October 23 was established in Mexico as Doctor’s Day during the Convention of Confederate Medical Unions of the Republic, held in the city of Cuernavaca, Morelos, in homage to Dr. Valentín Gómez Farías, since he inaugurated in 1833 the Establishment of Medical Sciences in Mexico City, which is the current Faculty of Medicine of the UNAM. In the rest of the world it is commemorated on December 3 since the year 1946.

According to the results of the National Occupation and Employment Survey (ENOE), for the second quarter of 2021, Mexico has 305,418 doctors, of which 54% are men and 46% women. There are around 620,000 nursing professionals, 70% of whom are women. With data from the OECD, Mexico has 2 doctors for every 1,000 inhabitants compared to 3.6 reported by other countries of this organization. The number of nurses is 2.9 and 8.8 per 1,000 inhabitants in Mexico and the OECD, respectively. In the country’s health system, figures from two years ago indicated that more than a million daily medical attentions are performed: around 4,300 births, close to a million consultations, almost 10,000 surgeries, more than 16,000 hospitalizations and close to of 100 thousand emergencies. Many of these data, such as emergency and hospitalization data, increased by a third with the pandemic; This information shows the great workload that exists within the health system.

According to INEGI, in 2021, 56.8% are consultations in the public sector and 43.2% in the private sector. Public spending on health is 2.76% compared to the 8.8% average for OECD countries; The WHO recommends at least between 6 and 8% of its GDP for public spending on health. Out-of-pocket spending in Mexico is generally 41%, but in some households it grew to 50% during the pandemic.

The above data is simply a superficial look at how the health system is lived politically and economically, but its main actors, who are patients and health personnel, especially doctors, have a very different chronicle of all this numeralia.

The doctor during his development of professional preparation, and then as an active part of care in the public system, experiences all kinds of circumstances and in many cases there are abuses by the authority and also by society in the demand for care to the population.

Currently it is considered that there are 140,000 students in 182 medical universities in the country, both public and private, and according to the QS ranking 2023 (which is a world ranking of around 800 universities worldwide) the top 5 universities to study medicine in Mexico are: 1.- National Autonomous University of Mexico; 2.- National Polytechnic Institute; 3.- Tecnológico de Monterrey; 4.- Autonomous University of Nuevo León; and 5.- Metropolitan Autonomous University.

Approximately one sixth of the students are in private schools.

Although the knowledge is the same, the way to acquire and understand it may be different according to the human and infrastructure resources available to each university and, of course, the student base in terms of their prior preparation. The requirement to enter each of these universities is the most competitive at the national level, which favors the preparation of the doctor based on competencies and the acquisition of skills so that the final product can guarantee better care for the population. . The costs paid at each university vary from 20 cents to 140,000 pesos per semester, such as between UNAM and Tecnológico de Monterrey respectively. This gives an idea of ​​the difference in terms of the resources that each student can count on during their preparation, however, more resources do not guarantee better preparation.

Most of the students when they finish, probably more for economic reasons than for professional interest, seek to do a postgraduate degree, generally a medical or surgical specialization and have to compete for a place in the National Examination of Applicants for Medical Residencies (ENARM). This year around 49,000 applicants were considered for around 18,000 places. It seems that it is above all in medicine where this pressure exists.

One of the greatest injustices in the path of being a doctor is the obligation to carry out Social Service, a task that represents a third of primary health care in the country. In Mexico, it has generally been established that social service lasts a minimum of 480 hours in a minimum period of six months and a maximum of two years. However, in medicine, when you go to rural areas, living in the Health Center, it is 24 hours a day, six or seven days a week that they are in their units for twelve months. The latter in accordance with NOM-009-SSA3 2013, with their respective vacation periods, with a monthly salary that is recently being modified from 5,996 to 7,429 pesos in rural and urban areas; this varies from 3,831 to 4,153 pesos. In addition to the insecurity and expenses of transportation and food, the doctor may be incriminated in legal problems that have medical responsibility, while they are still students in fact.

In INEGI data from 2021, 68% of doctors work in public institutions with a salary that can range from 17,000 to 26,000 pesos, depending on their category, whether it is a bachelor’s degree, master’s degree, or specialty and doctorate. Society and family life due to status and aspiration to economic improvements and job opportunities, push the doctor to seek a specialty. Upon completion, most choose to also work in private medicine.

Already as part of the staff of some institution, the doctor has to familiarize himself with union and administrative functioning of his institution and has to be subject to the demands of workload. Depending on the level of care, in tertiary care hospitals, the care load can be accompanied by teaching in both undergraduate and postgraduate courses. In many institutions, the level of competence of doctors is increasing, because in addition to having one or two specialties, they are forced to take a master’s degree and/or doctorate to better fulfill their professional activity. Many have even entered administrative-type master’s degrees so that if they have an administrative position, they can have a better performance in their position and be able to enter the National System of Researchers.

The area of ​​research is another issue, since there are practically no resources and they have to be sought from different parties, both nationally and internationally, from private or government initiatives such as Conacyt, but this institution makes permanence more and more difficult. of its members and resources.

Finally, the doctor, as a human being, is a political entity, however it seems that the vast majority prefer to have a distance from the political decisions of government health plans, although many times they act like a soldier, who does not seek do justice but only obey and unfortunately this can have consequences for the health of patients, as was experienced in many institutions during the pandemic.

Doctor’s Day is something that society and the medical community celebrate, however the political problem does not seem to change much. In 1939, in the X Convention of Medical Unions, the same ones that established the doctor’s day, demanded from the Ministry of the Interior that foreign doctors be subject to Mexican laws and regulations in order to practice; Today history repeats itself.

*The author is a medical oncologist at the National Institute of Cancerology (InCan), with a master’s degree in Direction and Management of Health Institutions, full professor of the Biological Therapies course, and has been a representative for Mexico of the cooperative group SWOG (South West Oncology Group). Currently in the dissemination project: Science, politics, economics and medicine.

joluagpo@hotmail.com