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ADMINISTRATIVE POLICIES AND MIR VACANCIES: IMPACT
ON THE SPANISH HEALTH SYSTEM
M2 Isabel Alonso Magdaleno
University of Oviedo
Key words: Simulation, Health, Model, Policies, MIR vacancies
This work shows the impact over the Spanish Health System of two policies that have
been used, and still are used, in the allocation of MIR vacancies. These policies are the
allocation of MIR vacancies according to the number of graduates and, the allocation
MIR vacancies according to the historical “bag” of graduates without specialty.
The first policy consists on allocating a number of vacancies similar to the number of
graduates. It is necessary to highlight that the number of MIR vacancies allocated has
been gradually increased, mainly at the end of eighties. The rate of coverage
graduates/MIR has increased, in a progressive way, until reaching 100% (until
allocating as many vacancies as annual graduates). Nevertheless, the number of
allocated MIR vacancies spreads at the moment, overcoming the number of graduates;
to give an exit to those that are in historical “bag”.
Regarding this administrative policy, it is settled down the hypothesis 1 by which the
management of MIR vacancies according to the number of graduates is an
administrative policy that benefits in the short-term to the graduates. Nevertheless,
starting from the current situation of the system, it harms them in the half and the long-
term, and it favors the evolution of the historical “bag”, worsening the evolution of the
specialized doctors “bag”.
Trying to validate the statement settled down in this first hypothesis a simulation, in a
scenario as the current one, was carried out taking in account the numerus clausus, the
retirement age’ and the current tendency of the system to be saturated.
By means of the simulation’ made, it is observed that the allocation of vacancies MIR,
according to the number of graduates, benefits the evolution of the historical “bag”.
Because there is more access to the system, due to bigger number of recently graduated,
and therefore it will be cut down the increment of itself. This causes the falling tendency
of the same one.
However, it is also observed that this administrative policy harms the evolution of the
specialized doctors’ “bag”. The “bag” grows, approximately, until the year 2016° and
then it begins to decrease (because the exits of the system begin to overcome the
entrances to the same one, which, in tum, will depend on the number of graduates and
also on the numerus clausus established every year).
The evolution of the "gap’” follows the same tendency that the specialized doctors’
“bag”. This way, the current great imbalance is observed between the supply and the
demand of specialized doctors. The "gap" begins to decrease when the social necessities
are increased, which will take place when the exits increase due to retirements and if a
saturated system is considered. From the peculiar distribution by age groups of our
doctors, it will be, approximately, about fifteen years when the effects of a bigger
discharge by retirement begin to be noticed.
On the other hand, the number of allocated MIR vacancies is carried out according to
the historical “bag” of graduates without specialty at the moment. From 1995, and with
the entrance in vigor of the Directive 93/16, the number of allocated MIR vacancies
* Supposing that they keep along the simulation the current numerus clausus — around the 4,400 vacancies in the Faculties of Medicine
(Diario Médico, 09/07/99)—- and the mandatory retirement age — 70 years (Diario Médico, 01/10/99, 04/10/99)—~
? Period of simulation: 2000-2020.
* The change of the growing tendency of the “bag” starting from that date is coherent with the predictions carried out by some of the
interviewed experts.
Imbalances among supply and demand.
spreads to overcome the number of graduates. With coverage rates, in certain moments
superiors to 100%, and trying to give an exit to the graduates of the year, and also to the
rest of graduates that are in the historical “bag?”.
In this way is settled down the hypothesis 2 by which the convocation of MIR
vacancies according to the historical “bag” of graduates without specialty is an
administrative policy that generates important imbalances in the system. It spreads to
the elimination of the historical “bag” and it hams seriously the specialized doctors’
“bag”.
The obtained results about the evolution of the “bags” and the specialized doctors’
"gap" are shown.
It is observed that an allocation policy according to the historical “bag” improves
considerably the evolution of the same one; since it only doesn't give exit to a bigger
number of recent graduated, but also to a bigger number of graduates in the “bag”.
Regarding the specialized doctors’ “bag” it is necessary to point out that their situation
will be even worst that in the previous case. An allocation policy based on the historical
“bag” supposes a bigger number of allocated MIR vacancies; and taking in account the
tendency of the system to be saturated, a policy of this type harms even more to the
specialized medical community.
The specialized doctors "gap", and like it was proposed, shows an important imbalance
between the supply and the demand of specialized doctors. The imbalance becomes
worse, even more, with a management of MIR vacancies based on the historical “bag”
of graduates without specialty.
In this work, a comparative of both policies is picked up: allocation of MIR vacancies
according to the number of graduates versus, allocation of MIR vacancies according to
the historical “bag”. This comparative is based on the evolution of the historical “bag”
of graduates without specialty. It is observed that this last policy benefits more to the
community in “bag” than the previous one.
On the other hand, the evolution of the specialized doctors’ “bag” is also observed
according to an allocation policy based on the number of graduates and according to the
historical “bag” of graduates without specialty. Both policies harm the evolution of this
“bag”, although the allocations according to the historical “bag” harm it even more.
By means of the simulation, it is observed the interrelation that exists among both
“bags” (the improvement of one of them implies to harm the other one).
The adoption of these proposal spreads to improve the situation of the medical
community in the short-term but in tum, it harms it in the half and the long term.
CONTACT:
Last Name: Alonso Magdaleno
First Name: M2? Isabel
Organization: University of Oviedo
Complete Postal Address:
UNIVERSIDAD DE OVIEDO
Departamento de Administracién de Empresas y Contabilidad
Facultad de Ciencias Econémicas y Empresariales -Campus del Cristo—
Avda. del Cristo, s/n —33071 Oviedo -Asturias, SPAIN
Phone: +34 985 10 36 99 Fax: +34 985 10 37 08
E-mail address: ialonso@ correo.uniovi.es (if there would be any problem, please contact me
at iam@ telecable.es)
° The next years will been allocated based on the historical bag (Diario Médico, 14/02/00; Europa Press, 05/04/00).
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ADMINISTRATIVE POLICIES AND MIR VACANCIES: IMPACT
ON THE SPANISH HEALTH SYSTEM
M? Isabel Alonso Magdaleno
UNIVERSITY OF OVIEDO
Departamento de Administraci6n de Empresas y
Contabilidad
Facultad de Ciencias Econdémicas y Empresariales
Campus del Cristo
Avda. del Cristo, s/n - 33071
Phone: +34 985 10 36 99
E-mail address: ialonso@correo.uniovi.es
OVIEDO - SPAIN
= HYPOTHESIS
H1. The allocation of MIR vacancies according to the number of graduates is an administrative policy that benefits
in, the short-term, the collective of graduates. This policy favors the historical “bag” evolution and harms
the specialized doctors “bag”; given the current situation of the system.
H2. The allocation of MIR vacancies according to the historical “bag” of graduates without specialty is an
administrative policy that generates important imbalances in the system. This policy spreads to the
elimination the historical “bag” and harms, seriously, the specialized doctors “bag”.
0
CONTRAST OF HYPOTHESIS (H1 Y H2). ADMINISTRATIVE POLICIESD
Graduates and Historical “bag”
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Years
Historical "bag" of graduates without specialty: SG70SNC
Historical "bag" of graduates without specialty: SHB70SNC "77777777777737770trrorrrerrrrersereereesenes
HISTORICAL “BAG”: Comparison
CONTRAST OF HYPOTHESIS (H1 Y H2). ADMINISTRATIVE POLICIESD
Graduates and Historical “bag”
La
[7
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
0
Specialized doctors "bag": SG70SNC
Specialized doctors "bag": SHB70SNC
SPECIALIZED DOCTORS “BAG”: Comparison
CONTRAST OF HYPOTHESIS (H1 Y H2). ADMINISTRATIVE POLICIESD
Graduates and Historical “bag”
La]
2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020
Years
Specialized doctors "GAP": SG70SNC
Specialized doctors "GAP": SHB70SNC
SPECIALIZED DOCTORS “GAP”: Comparison
