Medical schools criticize proposed changes to medical social services

Tuition fees for a medical degree in Bogotá in 2023 will range between 16 to 30 million pesos.

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At the end of November 2023, the Ministry of Health released a draft proposal that seeks to modify the provision of mandatory social services (SSO) in key points. It is a mechanism created by Law 1164 of 2007 so that graduates of higher education programs in the field of health can provide health services to depressed, urban or rural populations, or those with difficult access, for a period of at least six years. .months, nor more than a year. Although said project no longer appears in the draft proposals of the Ministry nor has much information been given about it through official channels, the issue came to light again due to a letter sent by Escofem (Colombian Association of Medical Schools) to Minsalud. Has emerged from.

To introduce the topic, it is important to first mention the changes proposed by that draft resolution. The document is based on the definition of the social nature of compulsory service: “(…) A burden has been placed on health professionals, derived from the principle of solidarity and justified by constitutionally legitimate objectives that are based on achieving benefits for the health system, bringing health services to areas that face difficulties in accessing them, and the health sector reconfigure the geographic distribution of professionals in the The ministry said that according to it, it is necessary to encourage the provision of this social service.

And for the latter, several articles were sought to be revised. In detail, several changes were proposed. For example, with regard to the length of service, the draft proposed that it would be six months for depressed, urban or rural populations or those with difficult access to health services, and one year in other cases. But perhaps the most significant change, in practice, concerned the elimination of social service exemptions. What happens today (according to Article 39 of 774) is that “professionals registered in the assignment process, who have no fixed place of residence, will be exempted from the mandatory social service.” This is because there are almost never as many places as there are students applying for.

The draft proposes to change it to the following: “Professionals registered in the assignment process, who do not have a place allotted, will have to register in the following assignment processes until a place is allotted to them in order to comply with the mandatory social service Is.” The document states that the ministry must provide information “necessary to encourage the creation of more places for the provision of essential social services”. Only those people can be acquitted who have already completed their social service in another profession or in the field of health. Apart from those who have completed compulsory military service or “citizens or foreigners who, even during this service, prove the impossibility of their service due to catastrophic illness, force majeure circumstances, force majeure”, which they must prove.

According to Escofem, the issue with these proposed changes is that, far from being intended, they could represent a number of problems. In the letter sent by the association to the Health Ministry on February 28, the medical schools have criticized many things. Regarding reducing the time for social services from one year to six months for “underserved urban or rural populations or those with difficult access”, Escofam says that “this may be disproportionate and contrary to the objectives of the reform Is.” Continuity of health care, one of the key elements for the implementation of the PHC strategy, is to configure health teams and increase resolution capacity at the first level of care.

According to the association, the processes of connecting, incorporating and adapting professionals to the institutions where they will perform social services take time, as well as understanding the context and characteristics of each area’s population, “which is why “Changes are being made in the health teams.” “Every six months is counterproductive to the implementation and consolidation of a preventive and prospective care model, especially for certain populations and areas that require greater connection between health teams and communities,” your letter may read.

In contrast, they propose that incentives should be established for social service positions in these populations such as, they add salaries and benefits commensurate with the cost of living in the area; premiums associated with access difficulties or climatic conditions; transportation, housing or food assistance; Reduction of part of the professional’s debts or obligations with official entities such as Icetex; In others. “In this way, it can also be achieved that some professionals voluntarily decide to stay longer than in SSOs.”

Escofam reiterates at this point that “it is necessary to improve the safety conditions of professionals who are going to comply with the SSO and guarantee the technologies, supplies and basic working conditions for decisive, humane and quality professional practice in health institutions and services Let’s give.” ,

Regarding the abolition of exemptions, medical schools consider it necessary, first of all, “that the national government guarantees places equal to or greater than the number of graduates of each profession, who must comply with the SSO for each.” Seat Assignment Procedures. The reason, he says, is simple: “If there are not a sufficient number of places, there will always be a number of professionals whose registration in the Rethus and, therefore, their authorization to practice their profession will be postponed indefinitely.” That is, with the abolition of the exemption, students who do not provide social services due to lack of places will not be able to have their professional card and, therefore, will not be able to practice their profession. (can see: Organ transplants to increase by 17% through 2023,

“This creates a completely unfair situation of uncertainty for young professionals who have spent six or more years training with the expectation of practicing their profession with autonomy and commitment,” the Escofam letter reads. This is problematic because, according to association data, the number of doctors graduating each year from 63 medical schools has been steadily increasing. While there were 5,246 graduating doctors in 2016, this will increase to 6,903 in 2022.

“If we do not guarantee an adequate number of OHS positions, the country will accumulate an increasing number of trained professionals who will be forced to remain inactive, which could have a negative impact on the development of their skills and capabilities, even That their mental health may also be affected. In a situation of complete uncertainty, there is no option but to wait. “This would be a regrettable and unjustified loss of human capital which the country needs as a priority.” Escofem remembers that many young people study health professions with “great financial efforts”. “A large portion of them have obtained million-dollar loans, in the best cases with institutions like Icetex, which is why it is important for them to repay the loan on time and start their professional and paid work practice without any delay Manner is essential.”

The union requests that the Ministry of Health, before approving the draft proposal, “publish the number of profession posts available in the country compared to the number of graduates of each profession, in such a way as to guarantee that recent “Professionals graduated in the U.S. will do so.” “Don’t become a victim of unreasonable waiting to start your professional and work activity.” In order to guarantee an adequate number of places, especially in priority areas and populations, Escofem proposes that a regulatory mechanism be created that “binds” the creation of places and/or a financing mechanism that funds the opening of said places. and ensures resources for maintenance. , Plaza. The letter is signed by Álvaro Enrique Romero Tapia, Chairman of Escofem’s Board of Directors, and Luis Carlos Ortiz Monsalve, Executive Director of the organization. Minsalud has not made any further references to this draft project, which is not yet firm.

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