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At ISSS, patients wait six months for an appointment due to a shortage of doctors

The “flight of doctors” at the Social Security Institute of Salvador (ISSS) has caused the average waiting time for an outpatient appointment to increase to almost six months, the ISSS Medical Staff Association (SIMETRISSS) warned yesterday.

In a new statement, SIMETRISSS expressed its concern about the impact the doctors’ departure has had on users. One of those consequences is a “serious problem with appointments,” said the union, which attributes the “leakage” to uncompetitive wages offered by Social Security.

The union compared the percentage of ISSS doctors with the number that the World Health Organization (WHO) considers necessary to provide essential health services to the public.

In 2021, indicated by SIMETRISSS, social security was closed with 2,236 doctors, including generals, specialists, subspecialists and dentists. In other words, that year they had 110 doctors for every 100,000 beneficiaries, 52% less than the 230 recommended by the WHO.

Only sub-experts added 478, that’s 28 out of every 100,000 users. Using this data, the union determined that there is an average of one subspecialist for every 3,572 users, but each one treats an average of 28 people per day, resulting in a 5.8-month wait for an outpatient appointment.

“This situation is becoming something very worrying and frightening, because of the flight of doctors (…). In outpatients, that is, the care of diabetics, hypertensive patients and different subspecialties, we see a lot of delays, due to the few doctors that the organization relies on,” said Rafael Aguirre, SIMETRISSS director, yesterday.

Aguirre said that 70% of the doctors who have resigned from the ISSS work in the Ministry of Health (MINSAL), where they are offered better salaries and many in the El Salvador Hospital. Another 20% work in the private labor market and insurance companies, while the remaining 10% have continued to work exclusively in the private labor market.

The ISSS doctor reiterated that in areas such as nephrology, there are only six specialists, and in several departments in similar situations, the institute has used in-house or general practitioners to care for patients who do not require specialized diagnosis, in an attempt to meet the demand. But in the opinion of SIMETRISSS, the situation requires more extensive action, taking into account the fact that the legislature recently agreed to include temporary agencies under ISSS coverage. Aguirre stressed that at the moment they do not know when this change will take effect and if Social Security will have a reasonable adjustment period.

For the union, the root problem is wages, and this requires “strong investment,” Aguirre said. One of the proposals they have sent since 2020 to the ISSS board is an equalization that allows an insurance doctor to receive the same remuneration as offered by MINSAL. The executive director of the union explained that since 2015 there has been no wage adjustment, but it has also been applied “against ourselves”. In other words, a newly admitted doctor starts getting the salary of someone who has been working with ISSS for 10 years, but the salary of someone who has been with the institute for a decade has not been adjusted, he added.

Another proposal is to allow weekends and holidays to attend outpatient meetings, a project that was implemented at the end of 2019 but was interrupted by the Covid-19 pandemic, to focus resources on dealing with the crisis.

Until yesterday, SIMETRISSS had not received a response on its options to face the “flight of doctors,” said Aguirre, who announced that they would seek support in Congress in the face of authorities’ silence. Since July 20, when SIMETRISSS publicly condemned the shortage of doctors, this newspaper has sought the official position of ISSS. Yesterday, he also requested their assessment, through his communications office, but at the end of this letter, no response was received.

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