“The specialist doctor is the only one who can recertify”

Javier García Alegría, Vice President of Facme.

After years of individual work and several months of joint work, the 46 learned societies that make up the Federation of Spanish Medical Scientific Associations (Facme) have converged their different models of medical recertification in a single project that they have presented to the General Directorate of Professional Regulation during a working day in which the General Council of Official Colleges of Physicians (Cgcom) has also participated. A meeting that, as revealed to this newspaper Javier Garcia Alegria, Vice President of Facme, has served to address the final details to be included in the model and obtain the commitment of Health to take into account its proposal in the design of the medical recertification in which the Ministry works. And it is as García Alegría assures, without scientific societies it will be “unfeasible” carry it out.

How do you rate the working day between Cgcom, Health and Facme?

It was very interesting and we are very satisfied. It is a milestone for different reasons. One of the fundamental aspects of yesterday’s meeting is the compromise reached to move forward and take into account the proposal that has been made, since the three legs of recertification were there. Aspects related to the periodic assessment of the profession have been agreed with the Cgcom. Before saying if we are good doctors, we must know if we are qualified to practice the profession.

As for Health, we have to thank the commitment of the new General Director of Professional Planning, Celia Gómez. We are facing a unique opportunity to move forward with this project that has been shelved for various reasons. It is about raising the level of self-demand even more and is a reflection of the commitment of doctors to society and patients.

Is the recertification model completed or will there still be modifications?

It is an almost final version. Several meetings have been called with representatives of the 46 societies and then work has been done with a specific group for operational work. It can still be modified, but I don’t think there will be many substantive changes. All societies have agreed to create a single model. It’s something logical and, furthermore, I think everyone will feel comfortable with it. We have decided on a structure of competences: 60 percent healthcare activities and 40 percent teaching, research and training

“The aim is to recertify professionals dedicated to care because there are others who are dedicated to teaching or pure research”

What aspects are measured in healthcare activities?

The day was not only for presentation, but also for questions and comments. It was very interesting because initiatives were contributed that will help us to perfect the final details. The aim is to certify a professional who performs a reasonable clinical activity on a day-to-day basis, that is, the aim is to recertify professionals dedicated to care because there are others who are dedicated to teaching or pure research.

How can healthcare activities be measured?

There are many ways. Hospitals and health centers have many records of what we do. Any professional can show the number of visits, interventions, emergencies… There is a lot of information available both in public and private centers that will allow accrediting the activity carried out.

Is the objective that this part be achieved in a simple way by practicing medicine on a day-to-day basis?

There are some very simple ways. I can request the number of people I have attended in external consultations, in hospitalization, in interconsultations… This is achieved automatically. It is not something punitive, but it recognizes the training. If someone is in a political or responsible position spending years away from the clinic, with this he will be able to redirect this situation and demonstrate again that he is qualified.

“There is a lot of information available both in public and private centers that will allow accrediting the activity that is carried out”

Will training that does not come from scientific societies be accepted?

It will be a shared training that can come from scientific societies, universities or the WTO. We have knowledge of specific subjects of the specialty, but there are other transversal ones such as ethics or health legislation.

Health has proposed a recertification every 10 years and you every 6 years. Why?

The model has been reviewed in different countries and there has always been talk of between 5 and 10 years. Perhaps less than 5 is a huge job for doctors and 10 years seems too long a period in relation to how scientific advances are going, in addition, it would be necessary to go back a long way to demonstrate the care capacity. This will have to be agreed because the last word is with the Ministry.

What role should scientific societies have in evaluating recertification?

We are clear that in order to evaluate the professional competence of the specialist doctor, the only one who can do so is another specialist doctor. It is such specific knowledge that it is the only way and this is done in all countries. It is proposed that each scientific society organize a technical evaluation committee.

“Less than 5 is a huge job for doctors and 10 years seems too long a period in relation to how scientific advances are going”

What did Celia Gómez think of the proposal?

She promised to take advantage of the work done. She already presented the document 24 hours in advance and yesterday the three parties made a commitment to carry out the project. Health will take into consideration the proposal of Facme.

The WTO has also made its proposal. Would you be willing to design a common model?

It is quite well established what is the responsibility of each one, and they are in charge of the periodic evaluation. They also offered to collaborate on other aspects of infrastructure and other issues because it remains to be defined how the regulation will be carried out. The fundamental scheme of evaluation of merits and deadlines is well agreed upon.

Would it surprise you if Health designed a model that does not take into account the Facme proposal?

It would be unfeasible to do so without the collaboration of scientific societies. We are facing a unique opportunity by having converged the 46 companies in a common model. There was a milestone in Spain with the incorporation of the MIR that changed Spanish healthcare and now this is another step that could be historic. We are in the best conditions to apply the recertification model.

Has Health given a date for achieving this milestone?

They have not given it to us nor could they. The general director has just arrived and she has been very kind and willing to listen to us and take us into consideration.

“For it to work well, the project has to be recognized from the administrative point of view and if it could also be much better from the curricular point of view”

Recertification is an issue that has been entrenched for years and there are even companies that have issued their own recertification because they are tired of waiting for Health. Do you have hope that this year it will be implemented?

It has to be approved as soon as possible, but for the project to work well it has to be recognized from an administrative point of view and if it could also be much better from the curricular point of view. I am referring to the provision of places, professional merits, transfers… If this were so, it would be a driving force behind recertification. In the end, this is an additional job and if this is reflected in a national-autonomous regulation of recognition, it would be ideal.

Are there any chances of achieving this recognition?

Yesterday it was raised, but the professional career depends more on the autonomous communities than on Health. Even so, the general director promised to analyze it.

Will they meet again with Sanidad?

We do not agree on a date explicitly, but implicitly. We convey our intention to meet as soon as possible to finish off the project.

The medical recertification will also apply to private health: “This is all Spanish health, regardless of the place of work”

What do you think about the incorporation of external companies to the recertification process?

This has more to do with reviewing international models and with training areas than with the design of the recertification model. We have proposed to Health that representatives of scientific societies participate in this technical group, as they are the ones who know best. We are not collaborating with them yet, but we hope so.

Will this model also be applied to private healthcare?

Yes. This was made clear at the meeting. This is all Spanish health, regardless of the place of work. Only that it is easier to obtain evidence in public hospitals because of the information infrastructure they have.

Has it been sought to be compatible with international models to facilitate movement to other countries?

It is that mobility is a fundamental requirement and that is why the European directive was born. If a healthcare professional has been working for more than ten years and wants to go to another country, it is likely that they will be required to be recertified.

Once the model has been presented, what is the next step that Facme is going to take?

In the next few days we will approve the proposal with the approval of all the scientific societies and we will send the final model to Health. In a couple of weeks we will finalize it, since it is already very advanced. From there we are at the expense of Health. We must remember that we have a debt with our country because we are not complying with the European directive and this at other times meant sanctions for Spain. We are late, and I am not saying this, but Europe is saying it.

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