I Express heads of service of internal medicine.

Spain, November 2011- The heads of service of internal medicine, that relate in this document, before the demonstrations by certain health authorities in connection with the Decree on core subjects and new medical specialties, wish to communicate the following:

1. Spain is by far the largest number of medical specialties-European country, therefore they would have to be very powerful and justified reasons to proceed with the recognition of new medical specialties, and thus move away, if possible, European reality.

2. A greater number of specialties is not synonymous with quality, and always carries entail a fragmentation of knowledge and health care, an increase in the costs and problems of viability and equity. It also means a greater number of visits per year to specialties different for each patient, with harmful effects for the health of patients and the economy of the system.

3. In recent years, we are witnessing a change in the need of health care for chronic disease pandemic. Many people suffer from many of these diseases for many years. These patients need professionals able to respond to all of them in a comprehensive manner. In relation to this, long time we have been expressing the need to adapt the training programs of the medical specialties to the health needs and the profile of current patients. This was the origin of the project’s core subjects which we have always defended.

4. Our services are a vertebral axis of healthcare for medical diseases in Spain, being responsible for 16% of hospital discharges, are represented in all types of hospitals and committed to the efficiency of the health system, quality and medical teaching.

5. Our specialty has been fundamental in addressing health care problems over the past decades such as medical emergencies, chronic diseases, pluripatológicos patients, HIV infection, or imported diseases.

6. The health care needs of high specificity which, undoubtedly, they exist because of the growing complexity of medical practice, they have their place and a framework in the Management Act of health professions with the recognition of areas of specific training which is to develop for years. Within them it may also include the areas of training of emergency and infectious diseases, thus recognizing the effort, dedication and contribution of value of multiple professionals from internal medicine and other medical specialties.

7. The Spanish society of internal medicine (SEMI) and the national specialty Committee have presented many grounded allegations, both form and substance, to the drafts of decrees of core subjects and new medical specialties. Us is unacceptable behaviour of certain health authorities that are answering in public allegations of other professional groups unless the Ministry has replied in writing to our allegations, following the channels established for this, with a clear lack of transparency and respect.

8. Decisions on health policy should solve problems without creating larger ones, and any approach to changing the educational system in medicine at the current stage of political uncertainty, economic crisis, and lack of consensus among scientific societies, must take into consideration the impact thereof.

9 We believe that the essential changes in the rearrangement of the specialized medical supply must obey the appearance again knowledge, substantial changes in the organisation of health systems or consolidated pressing needs of the assisted population and tend to synthesize, more flexible and give permeability to posgraduada training system. None of these situations can be seen in the decisions that we are claiming that they arise by corporate pressures and Union threats.

For all these reasons we oppose strongly the adoption of new medical specialties in Spain.

Its adoption would lead to the modification of existing portfolios of our clinical services, the training programs of our specialty, the reorganization of the health centres, and would require the negotiation of the possible double degrees of specialists, the reorganization in the supply of school places, and the definition of medico-legal responsibilities. All this without substantial evidence that will improve the quality of care or is going to facilitate the sustainability of the health system.

In such circumstances we would have to reconsider our support for the Decree and the introduction of the draft of core subjects in Spanish teaching hospitals.