Every Wednesday since Nov. 2022, over 1,000 healthcare workers in Madrid have staged walkouts in protest of working conditions which they say undermine their ability to provide proper care and threaten patient health. The striking physicians are demanding at least 10 minutes to see each patient in general medicine, and at least 15 minutes for pediatric patients. Deteriorating conditions are certainly linked to the ongoing COVID-19 pandemic, but doctors also suspect that the state may be intentionally undermining the public healthcare system in order to introduce privatized healthcare. This video is part of a Workers of the World series on the ongoing cost of living crisis in Europe.
Producers: Sato Díaz and María Artigas
Videographer and editor: María Artigas
Translator and narrator: Marina Céspedes
This story, with the support of the Bertha Foundation, is part of The Real News Network’s Workers of the World series, telling the stories of workers around the globe building collective power and redefining the future of work on their own terms.
Reporter: Neither the cold Madrid winter, nor the rain is stopping the striking primary care physicians and pediatricians who have been taking to the streets of Spain’s capital every Wednesday since November. Over a thousand healthcare workers come together weekly to resist the deteriorating conditions in the country’s healthcare system.
Jaime Roel Conde: We have been on an indefinite strike for two months all family doctors and pediatricians who work in primary care in Madrid.
Protesters: (chanting) Public healthcare!
Fran García: The reason why we have called the strike is basically to have time for patients in the consultation room. 10 minutes in family medicine and 15 minutes in pediatrics. To have more time to listen to them calmly, make a correct diagnosis and give the correct treatment. Conditions are very precarious. We are seeing 60-70 patients per day. There are times when we have two or three patients at a time in five minutes. It is impossible to work if you have no time. It takes time to provide quality patient care.
Reporter: The healthcare workers, who were considered heroes during the pandemic, have now been forgotten by the Spanish administration, especially in the Community of Madrid, the territory that includes the City of Madrid, governed by the ultraconservative president Isabel Díaz Ayuso. Madrid’s investment in healthcare ranks last in Spain, having only invested 1284 euros per capita in 2022. For this reason, doctors are mobilizing and the doctor’s union “Amyts” has been on strike since November 21.
Jaime Roel Conde: Primary care is the foundation of the healthcare system. It is the gateway. All patients enter through primary care and we, by doing our job well, are able to solve 80% of our patients’ health problems. This prevents the hospital from collapsing and from having to deal with all the health problems. Therefore, what we do is to ration our resources. Also, we are the one pillar of the entire healthcare system that is dedicated to prevention, to solving problems before they appear.
Fran García: In the last 20 years, because this didn’t start yesterday, primary care work has been deteriorating little by little because more family doctors and pediatricians weren’t hired. Positions of those who retired or were transferred were not filled, thus overloading the colleagues who are currently working with the workload of the ones that left. In general there are problems with family doctors and pediatricians in primary care throughout Spain, but there are certain measures being taken in other communities that were not implemented in Madrid. They are trying to hire more professionals and trying to give a little incentive to those who are left with modules of hours at a slightly higher pay than in the Community of Madrid. In the Community of Madrid practically nothing is being done.
Reporter: Poor working conditions are causing stress, anxiety and other health issues in the doctors themselves, who have been increasingly using PAIPSE, a program that offers comprehensive care for healthcare professionals. About 200 doctors from Madrid use this service. In addition, more and more doctors are leaving Madrid for other communities where working conditions are better. However, this is not slowing down the doctors in Madrid from continuing with their demands: they are asking for an increase in public healthcare funding, for more doctors to be hired with these funds, and for patient consultation times to be extended to 10 minutes in Family Medicine and 15 in Pediatrics.
Ana Isabel Díaz: Us professionals feel burned out by the situation we are going through, the stress at work and the patient overload. So much so that I am not going to be able to attend the whole protest because I have an appointment at PAIPSE today. PAIPSE is a program that provides comprehensive care for health professionals that currently treats a lot of primary care professionals, because we are all burned out due to the work situation we are going through. We are trying to raise awareness in the population, to make them see that we are not complaining about the money, we are not complaining for political reasons, we are complaining mainly because we are exhausted and we can’t take it anymore.
Protesters: (chanting) Now Madrid, Now we must clap our hands!
Adelaida García: I was alone at the health center for a period of time, without a substitute doctor to take over the other vacancy, I had to see around 40-50 children per day, between visits and phone calls, and on some occasion it was up to 70-80 patients. This makes it impossible to provide the children with the care they deserve.
Reporter: Doctors have even occupied a neighborhood association center in the city of Madrid. Since January 19th, dozens of doctors have been sleeping and occupying the building to pressure Díaz Ayuso’s government to accept their demands. The occupation, which began with 15 doctors, now involves about 150 healthcare workers.
Ana Isabel Díaz: Well, to support the lock-in protest, the truth is that we have the help of the neighbors who are amazing, who are wonderful, who bring us food. Our co-workers also come, they also bring food, they encourage us, they support us, the neighbors are great and the truth is that if it were not for them perhaps it would really be much harder. Well, this is the 14th day of the doctors’ lock-in. If us doctors have locked ourselves in and we have been here for 14 days, like I said, it is because we are extremely worried and we have to raise awareness in the population and realize that if we are doing this, which we should not have to, it is because we are very worried and have to find a way to make everybody aware of what is happening.
Reporter: The deteriorating conditions in primary care and pediatrics are leading to a decrease in patient care quality and disease prevention. Patients are being forced to go to hospitals and emergency rooms, which are becoming increasingly overcrowded which in turn, is leading to many people having to opt for private medical insurance. Coincidentally, the Community of Madrid’s conservative administration ranks first in private healthcare investment. They spent an average of 789 euros per capita in 2021 and are seemingly pushing the agenda of defunding public healthcare, in favor of the private sector.
Protesters: (chanting) These are the hands that take care of you!
Jaime Roel Conde: Well, what we are mainly asking for is that the Community of Madrid has to increase investment in primary care. Over the past ten years this investment has been declining more and more and we are losing more and more professionals, because the working conditions are not the most adequate. So we need more staff to be hired, we need a limit for the number of patients that can be seen in a day. We are asking for about 31 patients for family doctors and about 15 for pediatricians. And furthermore, what we are asking for is that a series of measures be taken to ensure the loyalty of doctors in training and to make sure that the residents who are trained every year in Madrid want to stay and work in Madrid. The suspicion we have is that the the Community of Madrid’s administration has a privatization plan. They begin to erode the primary level in order to achieve a poorer quality of service, and that finally results in the system gradually losing quality and thus achieving a progressive and surreptitious privatization.
Fran García: Well, we have to consider that if public health care fails, sooner or later private health care will fail. Private care does not have the capacity to take on all public care, so people should not believe that with a €50 insurance policy they will have everything solved. There will come a time when public care, public health, will fail, private care will overflow, and there will be services that cannot be covered because they do not have the support of public health care.
Ana Isabel Díaz: Many of the services are being privatized because they are not investing in primary care, so money is being given to the private sector to fill the private sector’s coffers, taking it away from the public health system. And that is much more costly. So we need that money to come to primary care, to the public health system, because it’s the fair thing to do for all citizens, and it does not discriminate on the basis of a patient’s bank account. It doesn’t matter if you have millions in your bank account or nothing at all, the health system will continue to take care of you and if you need a heart transplant, you will get it regardless of how much money you have. And if you need care for your child, you are going to get it no matter how much money you have. That is what we are fighting for.
Jaime Roel Conde: Public health is one of the fundamental pillars of the Welfare State. Here, in Spain, we have a Welfare State which could be better, but which has taken us many, many years to develop, and it is based on several fundamental pillars, one of which is health care. Health care is one of the backbone mechanisms of this society, because all Spaniards, all people residing in Spain, not only Spaniards, have the right to a health system, to a public health system which in principle is built to be a quality system, to ensure a better level of health for the population and that no patient, for any reason whatsoever, be exempted from this health system.
Reporter: The doctors’ fight is not only for their labor rights, but also for maintaining one of the social pillars of Spain: a public, free and universal healthcare system.
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