Conflictos del cirujano: ¿La vocación quirúrgica está en crisis? / Conflicts of surgeons: is surgical vocation in crisis?

RESUMEN Introducción: En los últimos años vemos un aumento de bibliografía que se refiere a problemas perso nales y psicológicos del cirujano, a la deserción en residencias de cirugía y a la falta de especialización de individuos jóvenes. Este aumento se observa sobre todo en revistas de jerarquía como Lancet o JAMA. ¿Pero cuál es la situación en la Argentina? ¿Consideramos que nos están pagando adecua damente por nuestra práctica? ¿Pensamos en abandonar nuestra especialidad? ¿Cuántos conflictos tenemos con pacientes por mes? Estimamos necesaria la realización de un trabajo regional que lo plasme. Objetivo: conocer la situación socioeconómica actual de los cirujanos. Material y métodos: estudio de corte transversal. Resultados: de 73 cirujanos encuestados de la provincia de Santa Fe, se recibió respuesta en un 57,5 %. El 87,8 % fueron hombres y 56,1% estaba dentro del grupo de edad adulto intermedio/mayor al momento del estudio. El 97,6 % de los cirujanos concordó en que sus ingresos no se corresponden con el tiempo invertido en la práctica. Consideraron abandonar su práctica diaria en el último año en un 26,2 %; la causa económica es el principal problema para el 72,7%. Discusión: la incomodidad del cirujano frente a su salario (97,6 %), la discrepancia de porcentajes en tre cirujanos y cirujanas (87,8% vs. 12,2%), la falta de cirujanos jóvenes (43,9%) y la alarmante cifra de cirujanos graduados por año (35 por año) son cuatro puntos clave que consideramos deberían abordar de manera urgente los entes políticos y, sobre todo, las Asociaciones de Cirugía.

ABSTRACT Background: In recent years we have witnessed more publications about personal and psychological issues affecting surgeons, residents quitting surgery residencies, and lack of specialization of young in dividuals. This growth can be observed especially in high-impact journals such as The Lancet or JAMA. But what is the situation in Argentina? Do we think that we are receiving adequate payment for our practice? Do we consider quitting our specialty? How many conflicts do we have with patients each month? We think that a regional work is necessary to reflect this situation. Objective: The aim of this study is to determine the current socioeconomic situation of surgeons. Material and methods: We conducted a cross-sectional study. Results: A total of 73 surgeons from the province of Santa Fe were contacted and 42 answers were received (response rate 57.5%): 87.8% were men and 56.1% corresponded to middle/older adulthood. Almost all surgeons (97.6%) agreed that their income did not reflect the time spent in practice. Up to 26.2% of survey respondents considered quitting their daily practice in the last year due to eco nomic reasons, which is the main problem for 72.7% of them. Discussion: Surgeons' discomfort with their salaries (97.6%), the discrepancy in percentages between male and female surgeons (87.8% vs. 12.2%), the lack of young surgeons (43.9%) and the alarming number of surgeons graduated per year (35 per year) are 4 key issues which we believe should be urgently addressed by political bodies and, especially, by surgery associations.

A regulação municipal ambulatorial de serviços do Sistema Único de Saúde no Rio de Janeiro: avanços, limites e desafios / Ambulatory municipal regulation of the Unified Health System services in Rio de Janeiro: advances, limitations and challenges

Resumo O federalismo é o pilar da República, composta pela união dos Estados, dos Municípios e do Distrito Federal, tendo como princípio básico a descentralização político-administrativa, nas relações políticas, econômicas e sociais. Na saúde, o provedor de atenção primária deve ser capaz de integrar todo cuidado que o paciente recebe através da coordenação entre os serviços. Objetiva-se avaliar os resultados dos encaminhamentos de consultas e exames ambulatoriais da APS do município do Rio de Janeiro, demonstrando os avanços, limites e desafios para a gestão no nível local. Estudo quantitativo que utilizou as bases de dados administrativas do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e o Sistema Nacional de Regulação (SISREG), além de uma "linkage" entre ambas as bases. Entre 2011 e 2015, o nº de procedimentos agendados teve um aumento de 86%, como reflexo da descentralização da regulação ambulatorial para os médicos de família. Pode-se inferir que não há falta de especialistas para atendimento ambulatorial no SUS carioca em quase todas as áreas. Existem gargalos artificiais pela ausência de regulação da maior parte da carga horária contratada na especialidade, ou seja, a oferta de vagas é menor do que a capacidade instalada das unidades municipal, estaduais, federais e conveniadas ao SUS.

Abstract Federalism is basis of the Republic of Brazil which is made up of the union of states, municipalities and the Federal District, with the basic principle of political and administrative decentralization in all political, economic and social relations. In the health sector, the primary health care provider should be able to integrate all care that the patient receives through the coordination of health services. This article aims to evaluate the results of referrals for consultations and outpatient examinations in primary health care in the municipality of Rio de Janeiro, highlighting the advances, limitations and challenges for management at the local level. A quantitative study was designed using administrative databases from the Registry of National Health Establishments (CNES), the National Regulatory System (SISREG), and a linkage between them. Between 2011 and 2015, the number of scheduled procedures increased by 86%, reflecting the decentralization of outpatient regulation for family doctors. It can be inferred that there is no shortage of specialists for outpatient care in the city in almost all areas. There are actually artificial bottlenecks that arise as a result of the lack of regulation of most of the workload contracted in specialist areas, that is, the number of vacancies is smaller than the capacity of health services available in health units at the municipal, state, federal levels and those contracted by the Unified Health System (SUS).

Formación de médicos especialistas en el Sistema de Servicios de Salud de Chile: Su evolución en el período 2007-2010 / Training of specialists in the Chilean national health services

Several institutions, such as the Ministry of Health, Universities, the Chilean Medical Association, Scientific societies and public opinion, recognize that there is a deficiency of specialized physicians in Chile. To overcome this shortage of specialists, the Ministry of Health, along with universities, is developing diverse initiatives to train specialists and cope with the requirements of the country. Seventy five percent of posts offered were filled by physicians. The number of positions increased from 173 in 2007 to 576 in 2010, with a cumulative total of 1582 physicians in four years. Fifty two percent are being trained in Basic Primary Specialties and 48 percent in primary specialties. Thirty three percent of graduates have the obligation to continue working in the public service during a certain lapse. This figure will increase to 50 percent in the following years. These specialists are mainly working in the more densely populated regions of the country. The universities that offer the higher number of training positions are the University of Chile, The Catholic University of Chile and the University of Santiago.

Formação e experiência profissional dos médicos prescritores de antirretrovirais no Estado de São Paulo / Professional background and experience of antiretroviral prescribing physicians in the State of São Paulo

OBJETIVO: Analisar o perfil dos médicos que prescreveram antirretrovirais (ARV) no Estado de São Paulo para o tratamento de pessoas infectadas pelo HIV. MÉTODOS: Foram analisadas as características sociodemográficas, de formação técnico-científica e a experiência dos profissionais que prescreveram os ARV entre outubro de 2007 e maio de 2009, utilizando-se informações obtidas nos bancos de dados do Ministério da Saúde, Conselho Regional de Medicina do Estado São Paulo, Comissão Nacional de Residência Médica e plataforma Lattes. RESULTADOS: A prescrição regular de ARV para 74 mil pacientes foi realizada por 1609 médicos, que apresentam distribuição similar segundo sexo, têm entre 30 anos e 49 anos, residem principalmente na região metropolitana de São Paulo, são formados em média há 16,1 anos, em 93 escolas médicas do país e possuem alguma formação em especialidades médicas (67,5 por cento), especialmente em infectologia (38,9 por cento). Cada médico prescreveu ARV em média para 10 pacientes, sendo que 51,6 por cento prescreveram para 20 ou mais pacientes. Entre os profissionais, 62 por cento reúnem conhecimento específico ou experiência para o tratamento de pessoas com HIV, sendo que 2,7 por cento das prescrições foram realizadas por profissionais que não apresentaram nenhuma dessas condições. Regiões com alta incidência de Aids apresentaram menor número de prescritores, como Barretos e Baixada Santista, reunindo as maiores concentrações de profissionais sem conhecimento específico ou experiência no Estado de São Paulo. CONCLUSÃO: A maioria das pessoas com HIV recebem prescrições de médicos que apresentam os requisitos de conhecimento e/ou experiência. Porém, o grande número de prescritores sem as qualificações mínimas e o reduzido número de médicos em regiões de maior incidência de Aids implicam importantes desafios para universalizar adequada atenção à saúde de pessoas com HIV.

OBJECTIVE: Analysis of the professional profile of physicians who prescribe antiretroviral drugs (ARV) to HIV infected persons in the State of São Paulo. METHODS: Databases from different sources, namely Ministry of Health, São Paulo State Regional Medical Council, National Commission on Medical Residency and the Lattes platform, were consulted. Data concerning socio-demographic characteristics, academic and professional background and experience for the period from October 2007 to May 2009 were analyzed. RESULTS: The regular ARV prescription for 74 thousand patients was issued by 1,609 physicians whose characteristics are: evenly distributed according to gender, aged between 30 to 49 years, live in the metropolitan area of Greater São Paulo, graduated 16.1 years ago on the average, come from 93 different Brazilian medical schools, hold a specialty diploma in 67.5 percent of cases, most of them in the field of Infectious Diseases (38.9 percent). The mean number of patients per physician was 10, though 51.6 percent of physicians prescribed for 20 or more patients. Of these physicians 62 percent reported specific knowledge or experience with HIV care , although 2.7 percent of all prescriptions were issued by physicians without this specific qualification. Regions of high AIDS incidence showed a smaller number of prescribing physicians. The cities of Registro and Ribeirão Preto showed the highest concentration of physicians lacking proper credentials. CONCLUSION: The absolute majority of HIV patients receives their prescriptions from duly trained and experienced physicians. Nevertheless, the large number of non-qualified physicians together with the reduced number of physicians in HIV high incidence regions make up the major challenge for comprehensive and adequate care of HIV patients.

Perfil epidemiológico del médico especialista en dermatología en la República Argentina 2008 / Epidemiological study of the dermatology specialist in the Argentine Rpublic 2008

En los últimos 25 años se han producido cambios en la política de salud desde diferentes Organizaciones (oficiales y profesionales) ha surgido la necesidad de analizar la composición, capacitación y distribución del recurso humano. El presente estudio tiene como objetivo conocer la distribución de los médicos especialistas en Dermatología, según jurisdicción e identificar información general de los especialistas. Como resultado fueron identificados 2750 profesionales relacionados con la especialidad y con residencia en el país; el 66 por ciento (1820) se corresponden con el criterio de inclusión tener título habilitante de especialista; el 15.7 por ciento (431) se encuentra cursando la especialidad; el 18 por ciento (494) fueron invitados por distintos mecanismos (Web, e-mails, notas) no pudiendo obtener su adhesión. De este 18 por ciento el 3.4 por ciento (95) no aceptaron participar; el 11 por ciento (296) no respondieron; el 2.9 por ciento (81) al momento de ser visitados se contató cambio de domicilio; el 0.8 por ciento (22) son médicos de otras especialidades que prestan servicios dermatológicos, tres manifestaron estar jubilados y dos habían fallecido. En el estudio se observa que el 78.5 por ciento son del sexo femenino; que el promedio de edad es de 47.4 años de edad, (26 años - 86 años), con una mediana de 48 años. La distribución no es uniforme en las diferentes jurisdicciones. La tasa general de profesionales proyectada es de 7.13/100000 habitantes.

In the last twenty-five years changes in health policy have taken place and from different organizations (officials and professionals) the necessity to analyze the composition, qualification and distribution of the human resource has arisen. The objective of this study is to know the distribution of the dermatology's specialist by jurisdiction and identify their characteristics. As a result were identified 2750 professionals related to the specialty and with residence in the country, 66 per cent (1820) meet the inclusion criteria "to have qualifying title of specialist", 15.7 per cent (431) is attending the specialty, 18 per cent (494) were invited by different mechanisms (Web, emails, notes) not being able to obtain their adhesion. Of this one 18 per cent, 3,4 per cent (95) did not accept to participate, 11 per cent (296) did not respond, 2,9 per cent (81) at the time of being visited was stated change of address, 0,8 per cent (22) are doctors of other specialties that serve dermatological, three declared to be retired and two had passed away. In the study it has been observed that 78,5 per cent are female, the average age of 47,4 years of age (26 years - 86 years). The medium is 48 years. The distribution is not uniform in all jurisdictions. The general rate of professionals projected is 7.13 / 100.000 inhabitants.