Health Opinion
Medical personnel in Mexico's public health system The few Mexican doctors who get past the opaque bureaucratic hurdles to work in the public health system often face low pay, uncertain employment and a lack of medical equipment and medicines. Cuartoscuro

Mexico’s ‘doctor shortage’ masks other public health shortages

Mexico is hiring foreign medical personnel to fill empty public health slots, but it should acknowledge why jobs go unfilled

Two weeks ago, I wrote about the government’s claim that there were not enough medical specialists in the country, resulting in Mexico inviting doctors from other Spanish-speaking countries, many from Cuba. The conclusion? Essentially, the government only opens a small number of spots each year for doctors to actually enter specialization programs in the first place, meaning that they actually decide in a very direct way how many specialists there are in Mexico.

After extensive conversations with various doctors around the country, I decided there was too much information for just one article; hence, this second one. This time, I’ll look at doctors through a labor-related lens, i.e., doctors as workers.

In every culture, we have extremely high expectations of doctors. Like we do with teachers, we expect them to be firmly dedicated to their vocation above all else…including their need to draw a dignified salary and enjoy a positive work environment. We look to them to save us when we’re at our worst. We want them to use the magic of science to do everything in their power to make us better. We want to be their number-one priority when we need them, no matter what they may be required to sacrifice in order to make that happen.

In other words, we expect them to be Jesus.

But doctors aren’t Jesus. They’re workers, with lives, families and a stack of bills to be paid each month, just like the rest of us, and if we want them to effectively do the job they signed up for, then their working environments must be adequate.

Now, a brief pause for a bit of recent history: we all know that AMLO flew into an easy victory on the platform of breaking up the “mafia of power.” That resonated with people all over the world – including me – but ultimately AMLO’s actions seem to have translated into the placement of simply different mafias of power, even as leaders claim that corruption in Mexico is no more.

Which is worse: open corruption that even the powers-that-be acknowledge or corruption that unofficially is all around us, but officially doesn’t exist?

Anyway, back to the topic at hand.

As a result of these kinds of changes, what used to be the Seguro Popular, for example, became the Bienestar (well-being) system, with changes from on-high in both structure and personnel. The result has been rather chaotic, especially in places that didn’t have a fantastic infrastructure in the first place. 

According to one doctor, the cost to the government of hospitalizing a patient for one night is higher than for any private hospital in the country. Even so, 70% of the budgets for public hospitals pay for employee salaries, while equipment and medicine are constantly in short supply. In poorer, less populous places, these things are simply absent. 

“If you’re poor and seriously ill in Mexico — especially if you’re not in a major city — you’re probably going to die,” one disheartened doctor told me.

Most frustrating is the fact that, while many doctors do all they can to heal and save their patients, there’s only so much that’s possible to do in the absence of the tools, equipment and medicines they need to do their jobs. 

The cardiologist might have her stethoscope, but no instruments for bypass surgery. The neurologist might be among the best of the best, but without an MRI machine, how is he to help sick patients? 

The difference in survival rates between public and private hospitals is overwhelmingly due to a lack of necessities; the doctors are the exact same people from private to public, and most doctors, even those with coveted plazas (permanent positions), also work privately to supplement their income.

For decades, a plaza with a public hospital like IMSS was the holy grail of medical labor. Salaries were high, benefits were many, and, hey: job security in a country where most people have none is a big plus. 

Salaries are decidedly not high anymore — a peek at the IMSS job board revealed an average base salary of merely 14,000 pesos, or about 700 dollars a month— though the myriad of benefits; job security; and, yes, a sincere desire to help the less fortunate ensure that there are always interested applicants regardless.

These plazas for specialists are the jobs that the Mexican government claims it’s unable to fill because of a lack of specialists in the country. The extent to which this is true is, at best, debatable.

One specialist I spoke with who works privately has been looking for a plaza in his state. He was told by the hospital administrators that there could be a plaza that might open up for him — if he paid for it. Much to their shock, he refused. 

The lesson? With the right contacts and plenty of money, plazas can appear, seemingly by magic.

So how do these hospitals have any doctors at all in the first place? Simple: low-paid contractors with no benefits. Many doctors do indeed accept these jobs as hospitals routinely dangle the remote possibility of a future plaza in front of them to keep them around. And of the doctors who do have plazas, acceptable absenteeism is built into the system.

As many as 20% to 30% of doctors in public hospitals might be absent because they’re allowed pases de salida (excused absences). And every single doctor I spoke to said they had colleagues who routinely went to the hospital twice a day just to punch their time cards in and out while attending to their private patients. 

I certainly don’t condone this – and feel incredibly sorry for the patients who can’t pay for their care – but I also understand that workers respond to how valued they feel.

When salaries stay low, the tools to do their jobs are absent and hospitals cannot reasonably guarantee their safety, it’s easy to see how some doctors might become outright cynics.

Hence, the arrival of foreign doctors, who, incidentally, are being paid 50,000–70,000 pesos for their work, according to another doctor familiar with several of the new arrivals.

Well, AMLO does seem to be a fan of throwing things out and starting over again. And the part of my brain that is willing to entertain conspiracy theories (we all have one) makes me wonder if there’s something about Cuban doctors specifically he loves: they have a reputation for being some of the best-trained doctors in the Americas, it’s true, but I also wonder if he’s specifically fond of people accustomed to falling in line or else.

We might not ever find out, but one thing is certain: the problem of “shortages” was created by a combination of corruption and the structural system itself. To find a real and fair solution, the government need not look anywhere besides the mirror.

Sarah DeVries is a writer and translator based in Xalapa, Veracruz. She can be reached through her website, sdevrieswritingandtranslating.com

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