Julio García Comesaña (Vigo, 1968) took the reins of Sergas at the worst moment of the pandemic, when the light at the end of the tunnel was not even visible and the deceased were counted by days. He made the leap from the management of the Vigo Integrated Management Area, after holding various management positions within the health organization chart. Specialized in Radiophysics, caution is one of his hallmarks and his management at the head of the Ministry of Health, which he inherited from Jesús Vázquez Almuíña.
A year ago we were still talking about restrictions by councils, limited capacity, outbreaks, screenings, and infections were measured by waves. Today there are about 26 people in the ICU, the positivity rate is close to 30%, but many experts are already talking about a post-pandemic scenario.
Are you optimistic or are you still being cautious?
I think that for a health minister to err on the side of caution is recommended. At the hospital level, which is what we measure the most, we have been in a stable situation since January. Around 20-30 patients in the ICU, and in the range of 500 admitted. There are many, although it is true that some are hospitalized “for” Covid, but most are hospitalized “with” Covid. At the hospital level, the impact is not minor, with moments of 600 admissions, which puts stress on the hospitals.
The percentage of unvaccinated in the ICU in Galicia became very high, what is the updated data?
Yes, it became a high figure, 70 percent in Cunqueiro for example, but right now it is 5 percent, which is equivalent to a single patient.
Will we have to get vaccinated again in the fall?
I think so, those over 80 without a doubt, the rest of the population there are doubts. We will respect what the Vaccine Report says, which is pronouncing more towards a vaccine with the original variant and the omicron. We will go towards a more open antidote to the two predominant variants.
How would you summarize current photography?
The situation is stable based on two legs: the high degree of vaccination and the characteristics of the variant. If any of these two things are altered, if we lose the protection from the vaccine or a variant with a different behavior appears, we will run another risk. The good thing is that this strain is very contagious, but not very lethal, despite the percentage of positivity. It is a stable balance, but we are anxious to put the fourth dose.
Vaccination centers became one of the symbols of the fight against Covid. Will it be necessary to reopen them for the new campaign?
If the target population is over 80, we will repeat with the health centers, because it has worked well. But of course the mass vaccination points were a success and they are there to dust them off if necessary.
The Covid bill has not been less for Galicia. 1,500 million more disbursements, 3,000 new professionals to meet the needs of the pandemic and increased waiting lists. The opposition speaks of collapse, are we facing a situation never seen before?
Indeed, it is a different situation from another because these reasons had never occurred, but after Christmas we were used to problems resulting from the flu virus and the demand in hospitals, which grew and forced operations to be suspended. It is true that these 600 patients are occupying beds and floors, and what is most pressing is the lack of specialists, especially in Primary.
Without leaving the hospital centers, the fire with the internists is not minor…
Yes, our recognition of internists, pulmonologists, microbiologists and preventivists, who have played a fundamental role in the pandemic, goes ahead. And if we say that in Galicia it has been managed well, it has been by internists, the most important service for admitted patients. That is why they have tried to strengthen. When the pandemic started we hired the residents a month before they finished their training, and they have stayed as long as necessary. We have reinforced the Internal Medicine guards to have people available and every possible effort has been made. But, as in the case of emergencies, they have had an extra effort that has been recognized in public and in private.
The friction is in the clause by which these specialists must move to other regional hospitals…
The situation is particular because Internal Medicine is very important in regional centers, where there are no other specialties. Our idea is to preserve care in these hospitals where the population has every right in the world to receive the best care possible. In the case of Orense, given the refusal of people who want to go to work at Barco de Valdeorras, despite the fact that we offer long-term contracts, we did not get people who wanted to go there. That is why the internists from the Orense hospital are going to cover the Ship’s guards. And this is inconvenient for them. As a result of this situation, we have put solutions on the table to guarantee the coverage of these hospitals and some Internal Medicine departments are having a hard time assuming it. What we are telling you is that you have to lend a hand in the districts and it is what generates this situation that you have to discuss to find the best alternatives.
Let’s open the MIR melon, Galicia offers 64 more places, an increase of 45% compared to the last call, with the emphasis on Primary. The deficit is alarming.
There are many factors to which we could dedicate hours, but there is a determining factor, which is that no one can be hired who does not have the specialty and who determines, authorizes and assigns the places to the MIR is the Ministry. And I have to say that they are not doing anything, especially with family medicine. And I explain. In 2018, the interterritorial council reached an agreement to reform the regulations of the year 95, when the situation of family doctors was different. It is a very rigid model that prevents increasing the number of specialists, so in 2018 an attempt was made to reform it, but nothing has been done since the socialist government arrived in Moncloa. Not even an increase in places in four years by the Ministry. Galicia made a public proposal of 30 measures in October, such as that they can train doctors beyond the age of 62 (now they cannot). It’s been over a year and we don’t know anything. With the old criteria we ask the teaching units for collaboration requesting 64 more places. We have asked that they be taken out in this call, but the Ministry has refused. The biggest problem is the lack of specialists, but that key is held by the Ministry, which does nothing to train more specialists, or to adapt to reality. The only thing he has done is change the system for choosing places, and that has left two hundred vacancies in Primary.
Galicia has the threat that in the next few years 30% of GPs will retire…
Yes, the same as in other communities. We are not a unique case. Galicia incorporated many family doctors in specific years and now the situation is the same.
Are the MIRs right who complain about precariousness, especially in the first years, and that is why they go to private practice? Know this complaint…
We do an analysis of the family residents that we have trained in the last ten years and 90 percent are working at Sergas. The problem is that since there is no emergency specialty, 50 percent of them last year in Galicia chose to go to the emergency room. So you are training specialists for PC, the only specialty with which you can contract, but they go to the emergency room because the Ministry does not want to create that specialty, which is another of the requests we have. But the central government is neither there nor is it expected.
There are no doctors and in the coastal councils they pull ingenuity for the summer. What do you think of the attempt to capture them through free housing like in Sanxenxo? The opposition speaks of marketing and criticizes that this only overloads the municipalities.
Before this measure, I would point out that Galicia offered the 106 MIRs who finish this year a place of ownership. If the problem was precariousness, and we are offering them an average salary of 65,000 euros a year, there would be no problem. The term ended on Tuesday, we still do not have figures, but it is a clear exercise and a commitment to community medicine. It seems good to us that a city council wants to make the destination attractive for doctors from outside Galicia, other communities are doing it, and Verín already did it when the delivery room conflict. We are not going to oppose.
With the MIR they ask that the court note be eliminated and also encourage the hiring of non-EU citizens.
Yes, it is because of the 218 seats that have been left vacant by the election system that the Ministry has put in place. In Galicia there were only 9 vacancies, much less than in other communities. The problem is the election method because before you went to the election in person and the available places came. The system now is digital and it doesn’t work well because before seeing the ones that are available you have to make a pre-selection and that doesn’t allow you to see the remaining slots in real time. The unions, the schools, warned that this model ran the risk of leaving vacancies and it has happened. Galicia spends 61 million euros of its budget to train the MIR and what we want is for all the places to be filled. An alternative is to increase the quota of non-community citizens, if it works, great, but that the 9 places are covered and they do not have to leave due to immigration problems. Another option is that this exam is not for medicine, it only orders the selection criteria, it is done by graduates in Medicine, we ask that they let the following fill the places. We don’t want to lose those 9.
For the moment, they have set themselves the goal of giving an appointment to 90% for Primary consultations in less than 4 days. What solution do health centers have beyond covering doctors?
In a pandemic we unload them with the massive vaccination points and the covid auto. It is in the sixth wave that generates a lot of administrative issues, the one that splashes the most in January. We reinforced with 75 retired doctors, we modified tools for registrations and cancellations, we created self-registration. We also bet on telephone consultation. In Galicia we do not have a problem of lack of doctors due to patient load, but there are two specific problems: as there are no substitutes, when you retire or are on sick leave there are no doctors. The vacations of the 2,000 primary doctors are not replaced because the workload drops in the summer and 33 percent leave each vacation period. But if one goes on vacation and the other takes leave, there is a problem. Another problem is the over-demand, people who go without an appointment and increase the appointments of the day. They are appointments that are forced.
And hence the XIDE. How is it working?
It is a tool that allows you to order the over-demand, that unscheduled appointment. A group of 50 professionals defined the 500 most common reasons for consultation, what they organize if they can wait and if they have to be in person. For example, a headache is seen in person during the day, but a report for the school is a delayed appointment and can be made by the administrator. If the patient insists, waits and is seen by the doctor, this does not force anything. We have discovered that there are many over-demand consultations that do not require a doctor to see them, our idea is to relieve the general practitioner of those consultations where her presence does not add value. Most of the over-demand is for analytics.
He assumed command of the Ministry a few months after the outbreak of the pandemic. He lived through a health earthquake and now a political one. How about his new boss?
The truth is that well, there are no criticisms because he is a person we knew well because in the pandemic we have had a lot of relationship with him and with the sectors that depended on hospitality and nightlife and the truth is that the relationship was always very good.
Galicia will be the first community to have a public center for proton therapy, fundamental in the treatment of childhood cancer. What deadlines are handled?
Yes, we already had a proton therapy project that was accelerated with the collaboration and purchase of the machinery by the Amancio Ortega Foundation. Now we have the blueprint, the location [on the Gil Casares plot of the Santiago Hospital], and we hope to be the first of the ten public centers to be created in Spain.
