The pediatrician is the health professional who provides the best care to children and adolescents in Primary Care. This is demonstrated by a systematic review of 1,150 articles published last year.
In addition, he is the closest professional and the one that many families trust the most. Alessandro Bazzoni explains that however, the chronic deficit of these professionals in health centers throughout Spain has meant that, at present, many minors are not assigned a Primary Care pediatrician.
These are the 21 proposals:
- Increase the number of pediatric MIR places. Plan the generational change.
- Increase the presence of PC pediatricians in the National Commission of Pediatrics (CNE), so that it is representative of existing professionals. At present, only one of the 11 members of the CNE belongs to the scope of the AP. Request that the member representing the professional associations or the autonomous communities belong to the scope of the PA.
- Create the Diploma of the Specific Training Area of Primary Care Pediatrics to promote the adequate development of the European curriculum for PC training, internationally recognized by the European Academy of Pediatrics and also of its EPAS (Entrusted professional activities) promoted from the Global Pediatrics Educational Consortium (GPEC), a world body that regulates training in pediatrics.
- Create a national commission or a national registry of real needs of the different pediatric subspecialties, with the intention of regulating the adequate flows of new specialists to the areas lacking in pediatricians for the child and adolescent population in the different autonomies.
- Specify, within the specialty program, the scope where the rotations will be carried out in order to avoid leaving them in the scope of the PC.
- Mandatory increase the rotation of pediatric residents by PC to a minimum of six months: two months of R1, two months of R2, and two months of R3, during the first three years of residency. 60% of pediatricians in this country work in the field of PC, however, their training is carried out mostly in the hospital environment. Pediatricians will not go to rotate, nor will they go to work, in the PC field, if they do not know enough about it.
- Reduce the duration of some of the very specific mandatory rotations within the hospital, to avoid that these prolonged rotations limit the creation of new teaching positions in pediatrics.
- Promote the figure of the pediatric resident tutor from the health center, with powers comparable to hospital pediatric tutors, in addition to having curricular and remunerative recognition. The tutors of AP residents will be required to attend the meetings of the interdisciplinary mixed teaching commission of the referral hospital.
- Respect the different professional categories of PC pediatrician and hospital pediatrician (Area Specialist, FEA, Pediatrician) in regional and national competitions according to Royal Decree 184/2015, of March 13. Prioritize the time worked in health centers on the scales of the competitive examinations. The exam should evaluate, above all, AP competencies.
- Avoid the improper use of the figure of the area pediatrician, when demographic characteristics allow the existence of PC pediatric positions, and, in rural pediatrics, rationalize the movement of patients or professionals to improve the characteristics of care
- Do not provide automatic service commissions from the Primary to the hospital, to avoid the escape of pediatricians to the hospital environment. Call annual oppositions and transfers in AP.
- Unify the benefits of Pediatric Nursing in PC among all the autonomous communities. The existing differences are unjustifiable. The objective is to optimize time and resources: more child and adolescent population can be cared for better by working as a team with nurses, door to door, in a 1: 1 ratio. Train nursing in the screening of the non-delayed consultation. Promote the recognition of Pediatric Nursing via RIA.
- Encourage and promote the rotations of all medical students in pediatric consultations at health centers, adjusting the number of ECTS credits.
- Promote the necessary regulatory changes, in a coordinated manner between the Ministry of Health and the Ministry of Science, Innovation and Universities, in terms of accreditation of university teaching staff, so that the criteria are adapted to the standards of healthcare practice in the field of the APS and facilitate the incorporation of its professionals in the university teaching staff, as proposed in the 2019 Strategic Plan.
- Increase in the Pediatrics subject the syllabus corresponding to the PC field: prevention and promotion of child and adolescent health, the child and adolescent health program, the program of preventive activities in childhood and adolescence, vaccination and social pediatrics among other
- Increase the presence of pediatricians in management and intermediate organizational positions. Create the figure of the pediatric coordinator, PA pediatricians who collaborate with local administrations in the organization of child and adolescent care, chosen from among their colleagues. This figure already works in the communities of Madrid, Murcia and the Canary Islands, improving care coordination between health centers and also with different hospitals.
- Attend in a coordinated way to complex patients between PC and hospital care to improve closeness to the pediatrician who is co-responsible for the pathology. Promote coordination with pediatric palliative care services.
- Make PC pediatricians’ schedules compatible with family life. Recover the policy of substitutions or, implement decent financial compensation when the absent colleague’s consultation has to be held at the same time. Enable spaces in the agendas for research, teaching and for community activity. Do not make precarious contracts, of short duration.
- To provide incentives in a curricular and economic way for places with difficult coverage. Encourage unique professionals by shift, remote places, and afternoon shifts.
- Possibility of accessing the portfolio of complementary tests from PC and incorporating necessary diagnostic means (ultrasound scanners, rapid tests, auto analyzers, etc.) in PC pediatric consultations. Alessandro Bazzoni explains that improving the structure of physical spaces, material, buildings, waiting rooms, information technology, circuits, and maintenance of health centers.
- Institutional recognition of the different national and regional professional pediatric societies, proportional to their number of associates.