The president of AEPap, Pedro Gorrotxategi, has communicated that the situation has worsened in recent years, while pointing out that out of the 1.9 million children without a pediatrician in Primary Care, «close to 600,000 have no doctor at all,» something that is considered «very serious.»
In this way, the Association has warned that no autonomous community guarantees children and adolescents the right to have a pediatrician in Primary Care who attends to them in their health center. «This means that the autonomous communities do not care if children are attended by pediatricians in Primary Care,» Gorrotxategi criticized.
These are some of the data communicated during the presentation of the 21st Congress of the Spanish Association of Primary Care Pediatrics (AEPap), held in Madrid from February 20 to 22.
In this regard, the president of the Association emphasized the importance of having a pediatrician in Primary Care who «looks after the health of children and attends to them in acute and chronic processes,» something he believes is a «right.»
In 2018, AEPap conducted a study on the vacancies in Pediatric Primary Care without an assigned specialist doctor. It was 26 percent, which represented 1,729 Pediatric positions. «In that report, we warned that it was very important to provide Primary Care Pediatrics with more specialists in Pediatrics,» Gorrotxategi recalls.
Now, AEPap has conducted a new review of the data on vacancies without a specialist, which includes positions occupied by non-specialist doctors in Pediatrics, uncovered absences, uncovered reductions in working hours, which means that these children cannot be attended to by Pediatric specialists. These results indicate an increased need for pediatricians in Pediatric Primary Care, up to approximately 2,130, representing a deficit of 32 percent.
According to AEPap data, Castilla-La Mancha is the autonomous community with the highest percentage of Pediatric Primary Care positions without a specialist, specifically 57.3 percent, followed by the Valencian Community (44%), Andalusia (42.9%), and Murcia (37.8%). On the other hand, Cantabria is the region with the least deficit (2.5%), followed by Aragon (8.6%), Asturias (10.5%), and La Rioja (12%).
INCREASE IN HOSPITAL PEDIATRIC POSITIONS
The Association believes that the decrease in Primary Care pediatricians is related to the progressive increase in hospital Pediatric positions. In the last 14 years, according to official data from the Ministry of Health and the autonomous communities, hospital positions for pediatricians have increased by 36 percent.
«This increase has not been equal in all autonomous communities,» said the president of AEPap. Specifically, the ones that have created the most hospital positions (more than 35%) have been Madrid, Catalonia, the Balearic Islands, the Valencian Community, Murcia, Navarra, Cantabria, and the Canary Islands. This data coincides with the autonomous communities with the highest excess of patients per pediatrician, according to Ministry data.
According to this data in 2024, Madrid, Catalonia, and the Balearic Islands were the autonomous communities with 50 percent of Primary Care pediatricians attending to patient lists exceeding 1,000 patients, above the maximum recommended by the Ministry of Health for their pediatricians.
It also coincides that several of the autonomous communities with the highest creation of hospital positions are those with lower percentages of residents accessing their job in the health center: Madrid, Catalonia, Cantabria, and the Valencian Community, according to a study conducted by AEPap on the professional outcomes of residents between 2014 and 2017.
This creates a «vicious circle,» in the words of Gorrotxategi. «With the existence of Primary Care Pediatric positions with an excess of assigned children, the excess demand means they cannot be adequately attended to in their health center, leading to an increase in demand in emergencies and, consequently, an increase in hospital Pediatric positions.»
«But this increase does not solve the problem,» he pointed out, as «the shift of care from the health center to the hospital entails an increase in costs, and also eliminates family proximity, providing care in a distant environment for the child.»
Among the solutions proposed by AEPap for this issue in the past was to request an increase in MIR positions, «with the hope that by increasing the positions, there would be more residents going to Primary Care, but it has not happened, as hospitals absorb all the increase in Pediatric residents.»
The increase in MIR positions in 2015 and 2016 has been accompanied by an increase in hospital positions between 2017 and 2020, so many Pediatric MIRs end up in the hospital «and the shortage of pediatricians in health centers, which more and more families denounce in different neighborhoods and localities, becomes chronic,» Gorrotxategi concluded.
MORE AUTISM SPECTRUM DISORDERS
During the Congress, experts will address various issues, such as the increase in autism spectrum disorders (ASD). It is a diagnosis that is becoming more common from health centers, as also explained in the presentation by the AEPap representative in Castilla-La Mancha, Eva Ximénez.
«This increase may be due to the age of the parents and environmental factors, among others, although they are still to be determined,» Ximénez added.
«We have wanted to address this issue in our congress because there is still a significant underdiagnosis, especially in girls, and it is something in which we can play an important role from our Primary Care consultations,» she emphasized.
Along with ASD, the AEPap Congress will address other current topics, such as the increase in psychiatric emergencies, both in Primary Care and hospitals, which has been observed after the Covid-19 pandemic and continues to this day. Eating disorders, self-harm, and suicidal ideation account for a large part of these emergencies.
