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EDITORIALS

Received: March 28^th 2016

Accepted: March 28^th 2016

Where internists work?

Manuel Ramiro-H.,^a Salvador Casares-Queralt,^b Angel Arévalo-Vargas,^c Irina Elizabeth Juárez,^d Octavio Noel Pons-Álvarez,^e Alejandro Castañeda-Del Toro^f

^aÁrea de Producción Editorial, División de Innovación Educativa, Coordinación de Educación en Salud

^bCoordinación de Educación en Salud

^cÁrea de Gestión y Control de Proyectos de Educación en Salud, Coordinación de Educación en Salud

^dDivisión de Programas Educativos, Coordinación de Educación en Salud

^eÁrea de Estudios de Posgrado, División de Programas Educativos, Coordinación de Educación en Salud

^fÁrea de Vinculación, Coordinación de Educación en Salud

Unidad de Educación, Investigación y Políticas de Salud, Instituto Mexicano del Seguro Social, Ciudad de México, México

Communication with: Manuel Ramiro-H.

Telephone: (55) 5623 2421

Email: manuel.ramiroh@gmail.com

For health institutions, knowing the fate of human resources within their classrooms is an extremely complicated task. Within the Instituto Mexicano del Seguro Social, where most specialists are trained in our country, with a clear orientation towards the pursuit of excellence and satisfaction of their needs human resources for health in Mexico is provided, hence the need to identify the professional profile and career destination of its graduates, which will be useful in the training of human resources for health.

Keywords: Health education; Teaching; Mexico

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An editorial was recently published signed by the President of the Colegio de Medicina Interna de México and the President of the Consejo Mexicano de Medicina Interna,¹ making several important considerations about the role that general practitioners have had on the development of Mexican medicine in recent years, and making an invitation to participate in activities at the Colegio and to continue certification and recertification, highlighting the importance that both have for internists to continue to provide quality and excellent health care, wherever they may work.

The Colegio de Medicina Interna de México, born the Asociación de Medicina Interna de México, has been instrumental in the development of internal medicine in our country and its search for identity and academic strength, thus its great use for the health system in Mexico. In the past 40 years, Internal Medicine has been instrumental in adult care, especially in secondary of care, at least at IMSS and ISSSTE, but most likely also in services granted by the Secretaría de Salud, as well as gaining ground in the private sector. It also has a strong role in tertiary care as an aid in managing complicated or difficult patients, and sometimes is also present in primary care. 

The Consejo Mexicano de Medicina Interna has developed an impeccable role in certifying internists, but has also played a key role in establishing the capabilities and limits on the exercise of their work. In their letter, López-Espinosa and Aldrete-Velasco made a comment that surprised us: "Until 20 years ago, 7 out of 10 internists who finished the specialty decided to remain general internists. However, something happened. Apparently to the younger generation it seemed more attractive once finishing the internal medicine specialty to do another specialty and work in that. Currently, out of every 10 internists who complete the specialty, only one remains in the practice of general internal medicine." Learning the fate of trained human resources is a very complicated task for health institutions as well as educational institutions, and even more so to discover the satisfaction in the work activities of their graduates.

Most of the training of specialists in Mexico happens in the Instituto Mexicano del Seguro Social, with a clear orientation towards the pursuit of excellence and the satisfaction of their human resource needs for health.^2-4

We decided to do a preliminary exploration of what was happening at IMSS, looking, at least in the short and medium term, at where internists settled to work upon graduation. We analyze the graduates from the past five years, comparing the figures of matriculation with graduation, only looking at those who finished the complete specialty, without taking into account those who after joining were intended to be part of studies the Internal Medicine specialty and then continue with any of the subspecialties, and we compared figures of matriculation with graduation to obtain a percentage. As at IMSS, demand for specialists is continuous and increasing; every year near the graduation of a class of specialists, the authorities of the Institute and their union organize an event where places are awarded to graduates. It is an institutional, social, and professional event, but for each graduate it is a momentous time when looking and, most likely, getting a job, the first of their nascent career as medical specialists. We compared the number of those who obtained a job offer versus the number of graduates and the number who entered (Table I).⁵

As noted, the results are different from what was stated in the editorial to which we refer, since 87% of the graduates are working as interns at the Institute itself; it is true that not everyone has a definitive contract, but interim contracts very often constitute permanent positions in the short and medium term.

Particularly striking is the difference between those entering and graduating, which has a percentage during these five years varying from 38 to 14% (average is 26). While it may be due to academic defections or motivated by different social phenomena, it is probably also influenced by the fact that Internal Medicine, despite efforts, has no strong and clear identity, and a number of those who leave the specialty do so for this reason, disappointed.

Of course, there is a demand for the services of internists throughout the Health System,³ which is probably due to the development of the system itself and the need for generational change. Ariza and Lifshitz6 have made a magnificent analysis of the development of Internal Medicine and its needs for constant change and adaptation to systems.

It is probably useful to know job destination and satisfaction in the medium and long term, of resources trained in different health institutions with the support of different medical academies and schools, for together we should establish a plan to discover this data in a program perhaps coordinated by the regulatory authority. Surely it will be useful in the training of human resources for health.

References

1. López-Espinosa R, Aldrete-Velasco J. Porque queremos que regreses a casa. Med Int Mex;2016;32(1): 159-160.
2. Arévalo-Vargas A, Ramiro M, Dávila-Torres J. Suficiencia, oportunidad y calidad, los desafíos al planificar la formación de médicos especialistas. In: Echevarria-Zuno S, Lifshitz A, Casares-Queralt S, Arévalo-Vargas A (ed). La Educación en Salud en el IMSS. México: Instituto Mexicano del Seguro Social; 2012: 29-44.
3. Echevarria-Zuno S, Lifshitz A, Casares-Queralt S, Arévalo-Vargas A. La formación de médicos especialistas un reto a corto plazo. La solución una política pública. In: Echevarria-Zuno S, Lifshitz A, Casares-Queralt S, Arévalo-Vargas A. (ed). La Educación en Salud en el IMSS. México: Instituto Mexicano del Seguro Social; 2012: 47-61.
4. Casares-Queralt S, Arévalo-Vargas A. Educación en Salud. Compromiso con la excelencia. En: Fajardo-Dolci G, Casares-Queralt S. (ed) Educación en salud. México Academia Mexicana de Cirugía. 2013:9-18.
5. Archivos de la División de Programas Educativos Coordinación de Educación en Salud del Instituto Mexicano del Seguro Social
6. Ariza-Andraca RC, Lifshitz A. Medicina Interna. In: Fajardo-Dolci G, Graue-Wiechers E, Kershenobich D, Vilar-Puig P. (ed) Desarrollo de las Especialidades Médicas en México. México: Editorial Alfil; 2012: 273:276.

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