Professional situation of young medical specialists at the end of their residency in Barcelona

Bataller-Bassols, Adriana; Terán Díez, Mónica; Romaguera Piñol, Anna; Camps i Fondevila, Berenguer
doi:10.1016/j.medcle.2015.05.035
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The economic crisis and the reductions applied to the health system have prolonged during 2013&#44; with budget reductions affecting the medical community&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> According to the Spanish Public Employment Service&#44;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> the total number of unemployed specialist physicians registered in June&#44; 2013 was 2&#46;886&#44; that is to say&#44; 20&#46;1&#37; higher than 2012&#46; In addition&#44; that same month&#44; the number of licensed physicians seeking for a job has amounted to 5&#46;253&#44; excluding the number of internal medicine residents &#40;IMR&#41; who graduated in May&#46; The <span class="elsevierStyleItalic">Col&#183;legi Oficial de Metges de Barcelona</span> &#40;COMB&#41; monitors the employment situation of physicians who completed their internal medicine residency&#44; in order to support the specialists who join the labour market in times of economic turmoil&#46; A study was conducted on the initiative of the IMR Professional Group&#44; and by means of the Employment Service of the COMB&#44; in order to assess the professional situation and labour insertion perspective of young specialists&#46; Its main goal was to reveal the labour situation progress relate to this community&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">The study subjects were specialised physicians who completed their medical residency in the province of Barcelona in 2006&#44; 2011&#44; 2012 and 2013&#46; Thanks to the professional group database&#44; it was possible to identify those specialists who had completed their residency during the years mentioned above&#44; and to prepare a structured questionnaire to facilitate sociodemographic&#44; academic and labour data collection&#46; The questionnaire was sent by email and courtesy reminder phone calls were made in order to gather as much information as possible&#46; A descriptive analysis was used for the statistical study&#44; and a bivariate one was used for the contingency tables&#46; The statistical analysis was made with SPSS<span class="elsevierStyleSup">&#174;</span> version 17&#46;0&#46; There was a sample error of 1&#46;95&#37;&#44; on the basis of normal distribution&#44; maximum uncertainty and a 95&#37; confidence level&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The number of young specialists who answered the questionnaire was 1&#46;217 &#40;52&#37;&#41; out of a total of 2&#46;338 study subjects&#46; Two-thirds of these specialists were female&#44; and the vast majority of them were between 28 and 33 years old&#46; The employment situation of physicians by the time of completing their IMR is seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; The percentage of foreign physicians who completed their IMR went from 1&#46;8&#37; in 2006 to 32&#46;3&#37; in 2013&#46; There were no relevant differences registered gender-wise regarding labour insertion&#46; However&#44; there were significant differences registered in terms of labour insertion regarding the origin of the university issuing the professional degree&#58; Spanish &#40;76&#46;0&#37;&#41; or foreign &#40;54&#46;5&#37;&#41;&#46; There was also disparity regarding labour insertion rates in terms of groups of speciality&#46; Thus &#40;2013 data&#41;&#44; the labour insertion rate in medical-surgical specialities was 82&#46;0&#37;&#44; whereas it was 71&#46;7&#37; in surgical specialities&#44; 67&#46;2&#37; in medical specialities&#44; 59&#46;1&#37; in central services&#44; and 62&#46;7&#37; in family and community medicine&#46; The level of labour insertion in obstetrics and gynaecology was the best for 2013 &#40;87&#46;5&#37;&#41;&#46; The number of specialists who became employed doubled within the private sector&#44; rising from 9&#46;3&#37; in 2006 to 20&#46;5&#37; in 2013&#46; The concentrated sector went from 44&#37; &#40;2006&#41; to 32&#37; &#40;2013&#41;&#46; The public sector remained stable between 2006 &#40;49&#46;3&#37;&#41; and 2013 &#40;47&#46;5&#37;&#41;&#46; The highest proportion of indefinite work agreements &#40;28&#46;3&#37; in 2013&#41; was observed in the private sector&#59; temporary work agreements decreased in terms of duration&#44; and the number of annual work agreements decreased as well &#40;from 33&#46;7&#37; in 2006 to 23&#46;9&#37; in 2013&#41;&#46; The economic retribution suffered a drastic reduction between 2006 &#40;43&#46;8&#37; declared receiving an income higher than 2&#46;000 &#8364; a month&#41; and 2013 &#40;the amount dropped 19&#46;5&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Labour insertion for physicians who completed their IMR course remained considerably high&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> with reasonable insertion levels compared to other graduate degrees&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> According to our analysis&#44; the origin and speciality variables were determining factors for the professional situation&#46; The worst overall results in the IMR exam were seen among physicians with foreign university degrees&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> who were forced&#44; in some cases&#44; to choose specialities with the worse prospects of employment&#44; not considering all the red tape hindering their labour insertion&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The significant increase in labour instability was also revealed&#58; there was a reduction in the number of indefinite work agreements&#44; and the duration of temporary work agreements decreased&#46; The situation may have been partly alleviated by the increase in the proportion of workers employed by the private sector&#46; The economic and budget scenarios in Catalonia<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> do not seem to indicate a promising reversal of this situation in the near future&#46; In view of the aforesaid&#44; the professional future of young specialists seems to point in the direction of more difficulties to attain insertion in a labour market with a growing employment instability&#46; It must also be borne in mind that a population&#39;s health depends on the improvement of conditions offered to physicians for their career path development&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This work has been made with means and resources from COMB&#44; without external additional funding&#46;</p></span></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Employment situation by the time of IMR completion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Employed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Seeking employment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Master&#44; postgraduate degrees&#44; etc&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Starting another IMR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " colspan="5" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Type of work agreement for internal medicine residents who find a job</th></tr><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First work agreement by the time of IMR completion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Temporary employment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">36&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Indefinite employment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Substitutions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">On-call schedule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Interim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Scholarship&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Self-employed&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
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            0 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;E&#46; Harris"
                            1 => "B&#46; Gonz&#225;lez L&#243;pez-Valc&#225;rcel"
                            2 => "V&#46; Ort&#250;n"
                            3 => "P&#46; Barber"
                          ]
                        ]
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                    0 => array:2 [
                      "doi" => "10.1136/bmjopen-2012-002051"
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                        "tituloSerie" => "BMJ Open"
                        "fecha" => "2013"
                        "volumen" => "3"
                        "paginaInicial" => "e002051"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23408072"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
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              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Junio camufla el paro m&#233;dico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Leo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2013"
                        "editorial" => "Redacci&#243;n M&#233;dica &#91;diario digital&#93;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio sobre la evoluci&#243;n profesional de los especialistas egresados de la Formaci&#243;n Sanitaria Especializada 2006-2011"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Ministerio de Sanidad&#44; Servicios Sociales e Igualdad&#46; Gobierno de Espa&#241;a"
                          ]
                        ]
                      ]
                    ]
                  ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Generalitat de Catalu&#241;a&#46; Universidad y trabajo en Catalu&#241;a 2011&#46; Estudio de la inserci&#243;n laboral de la poblaci&#243;n titulada de las universidades catalanas"
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                      "titulo" => "Los resultados del MIR 2012&#47;2013 clasificados por facultades"
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                          "autores" => array:1 [
                            0 => "J&#46;M&#46; Romeo"
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                          "etal" => false
                          "autores" => array:1 [
                            0 => "Departamento de Econom&#237;a y Conocimiento&#46; Generalitat de Catalu&#241;a"
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                    0 => array:1 [
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                        "fecha" => "5 November 2013"
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        "texto" => "<p id="par0035" class="elsevierStylePara elsevierViewall">Thanks to Farmers Llimona for their support in the field work completion&#44; from the professionals&#8217; assistance unit &#40;COMB&#41;&#46; Thanks to Empar Gil&#44; Mari Ortiz and Patricia P&#233;rez&#44; from the COMB Employment Service&#44; for their contribution in processing data&#46; Thanks to the COMB Governing Board&#44; for their support to this initiative from resident physicians&#46;</p>"
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