Thursday, July 7

A month of struggle for (almost) nothing: the MIR choose a place pending “a lottery”


It’s 13:30 on Tuesday and Óscar doesn’t know what to do anymore. He does not know whether to re-simulate the process to make sure everything is okay for now, whether to go for a run to stop thinking about it, or whether to videoconference with his girlfriend Maria to reassure each other. This Tuesday is probably the day – or one of the, at least – most important in recent years for both of them, doctors at the gates of the MIR. This Tuesday his professional future is decided, and also personal for the next five years. This Tuesday, a computer will award them the position that they will both occupy for the next five years without the possibility of changing it. “It’s a bit of a lottery,” he laments.

Is it that the MIRs do not have enough with our applause?

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And the stakes are high, says Óscar on the other end of the phone. His voice denotes a certain nervousness, although he does not lose his good humor. You have until 5:00 p.m. to finish entering your list of preferences (what specialty to do and in which health center in Spain) on the platform that the Ministry of Health has enabled to award the places. From there, three hours of pure nerves until at 8:00 p.m. the algorithm begins to allocate places in order of the exam grade. Without them being able to do anything, the computer will distribute the places that become available from candidate to candidate, according to their previously established order of preference and the vacancies. An email from Health will resolve the question: either they have squared the choice and have been lucky and will be able to reside in the same municipality (or at least close by) or for whatever reason (the simulation was not correct, someone changed their mind) They have five years to search for each other in Spain.

Óscar and María are two among the thousands of health workers who have spent a month protesting against the Ministry of Health for the change in the system for choosing places for specialized health training (the famous MIRs, but also other profiles do residencies, such as nurses, biologists, psychologists, ray technicians, pharmacists). Two months of protests, demonstrations, negotiations with the ministry led by Carolina Darias that have resulted in some partial improvement that has been appreciated, but without achieving the main objective that was sought: to return to the previous model of election.

The change of model

Until last year, the allocation of places for specialized health training had been done under a model of direct choice in real time. By order, depending on the grade obtained in the entrance exam, the health workers were summoned at the headquarters of the ministry and they were choosing a place. The number 1 of the promotion chose first: specialty and hospital (this year Daniel Gómez has selected Cardiology at the San Carlos Clinic in Madrid). At that moment, that square disappeared and the next person on the list had a few minutes to choose his destination, with the information of the available places in his possession. Thus, one by one, the places were distributed. The important thing about this system, the candidates insist, is that each person actively chose the destination with all the available information.

This was how it worked until last year, when the Health pandemic changed the method so as not to have to summon candidates in Madrid. A hybrid telematics system was designed – which ended up knocking the Supreme Court down – as an emergency solution that was thought to be a temporary patch. But not. To the surprise of the MIRs, they say, the ministry delved into the method for this course and announced that the election would be fully automated. Each candidate should fill in a list with their favorite places, in order of preference, and when the day comes, an algorithm will automatically award them.

The health workers did not like the decision. They did not understand, they do not understand, that Health was leaving their professional destiny in the hands of a kind of chance. Directed, but random. The ministry recommended that candidates fill in as many entries as their election number on their list, something unaffordable for some. “I am number 5,415,” explained Alejandro Cuéllar, who became the spokesman for the FSE Platform, which brought together the struggle of the health workers. “Health recommends that I make a list of at least 5,416 options”, illustrated the first proposal of the ministry. The candidates argued that even if each person drew up a list of preferences, it was impossible to foresee what position each candidate might get –especially for the highest numbers– and that the decision is too important to be left to an algorithm, not to mention of the unaffordable of making a list of several thousand entries.

The health workers obtained the unanimous support of the professional associations of doctors and nurses, of the training managers of the hospitals, of the deans of the faculties of the health degrees. The entire sector defended their claim. They organized protests in Madrid which were attended by candidates from all over Spain, they met with those responsible for Health, they even made a threat of closure at the headquarters of the ministry one day when they were negotiating for 12 hours.

“A lot of dialogue, but the answer later is no”

They got some partial victory out of that fight, but they lost. They lost if it is understood as such that they did not achieve their main objective, which was to return to personal choice in real time. At the same time, they filed a petition before the courts to suspend the process as a precautionary measure. The National Court passed the ball to the Superior Court of Justice of Madrid and between one and the other they both declared themselves incompetent to do so. Another closed door.

The margin is over, the algorithm would decide, although Health did offer some improvements, such as allocating places in shifts of 400 people each day, so that others can see which places are no longer available, limit more with their preferences and limit the number of lists 400 entries maximum in worst case. “It has been appreciated”, grants the nurse Alicia, “I did not need it, but to many people of the following shifts it did help them to adjust their lists”. In her case – the nurses have already gone through the process – the choice has gone well, although she defines the process and waits for it with the word “anxiety”.

Cuéllar, the candidate who has been the spokesperson who has led the negotiation together with other colleagues, has been left with a bitter aftertaste from the entire process. “The administration fills its mouth when talking about the jewel of the health system, they have not been able to control the wick of the toilets, they are fed up.”

The MIRs are left with a feeling of helplessness and of having been used during the last year. “After a year of pandemic in which all groups have had to sacrifice themselves in many situations, the students of Medicine and Nursing were begged to step forward [para trabajar en hospitales]. In this situation, applause began to be given to the toilets. But then they get this system out. For a month we are in demonstrations, negotiations … we do not achieve anything, until in the second demonstration they tell us that things that were impossible are already impossible, such as doing 400 shifts. This is the feeling we have in health training specialized. A lack of control and little concern for the national health system, “sums up Cuéllar.

Edurne was also in negotiations with Health. He sums up his foray into political bargaining as “frustrating.” “There have been many meetings, a lot of dialogue with the ministry, but they were very closed in band. Many answers were ‘no’ and that’s it. We do not know why this interest in a turn-based system. They closed on that. It was like talking to the wall, but they sell it as something phenomenal, “he describes.

Health has always defended that access to public administration is done mainly with this method of telematic adjudication and that the MIRs were more exception than anything else. “The electronic place allocation procedure is safe and reliable”, defended the ministry, it complies with the regulations and also the system is “traceable and transparent” in case of claim, “more agile, allowing the incorporation to the assigned place in more time limits. short “and” more efficient, since it reduces unnecessary travel of applicants to the headquarters of the Ministry of Health, “which is especially important in a pandemic to avoid infections, according to the ministry. Then he conceded that dividing the award into shifts would facilitate the process for the candidates, although the new distribution generates paradoxes as it may be better to choose the 401, the first of your day, than the 389, the last of the previous one and with much less control about the final destination.

“It gives a lot of courage”

It is after 5pm and Óscar and María have closed their lists. The die is cast. Their case is especially delicate because they aspire to reside in the same municipality, or at least reasonably close. They have been lucky, they took a practically nailed exam and they choose almost in a row (she has the number 463, he has the 473) among more than 10,000 candidates. And yet even that does not guarantee that the algorithm will award them the places they want.

“You can’t imagine how we are,” says Óscar. Now he is going to run, the house is falling on him. “Coordination has been a mess. Maria wants to do Dermatology, I want Oncology. We had chosen Madrid, but now [en el segundo día de reparto] there are only places of derma in Fuenlabrada and Parla hospitals, we hope that no one takes them, “he says. His Oncology position seems more assured, according to the election simulator that the candidates themselves have made to try to get an idea of ​​what they can aspire to and what not.

Maria’s is in the air. After Parla and Fuenlabrada come Toledo and Guadalajara … and if not heading to their Malaga and distance relationship. And there is nothing they can do, just try to square their preferences “and pray”. “It gives a lot of courage that after having worked so hard, to do the MIR together, then to fall next to each other [en las listas] and after so much effort, everything is pending in a lottery and we have to count on luck, in addition to the work done, so that we find an option with which we are satisfied. If the election were face-to-face and I saw that she had to take Seville, for example, I could also choose Seville “, laments Óscar.” You have a very good election number, but with this uncertainty it seems that everything has gone wrong. ”

They give the 19.55 and in Oscar’s inbox enters the email of the ministry that tells them what place has been assigned. Your first choice. With that they already had, the agony lasts for a couple of minutes until Maria’s enters. Success, Madrid has also fallen for him. In his case, the story finally has a happy ending. The improvement in Health by grouping the candidates into groups of 400 has allowed the candidates to be chosen much more accurately. In any case, the first choices seem easier because there is more offer. Thousands of people will continue to await the process in the coming days. The final balance, including the fear of the candidates that many places will be rejected because they only fill out the lists – which would be lost – remains for later.



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