Private healthcare has a powerful calling effect for public dermatologists in Madrid. Six of the 28 heads of that specialty in the autonomous system have joined businessmen in the sector, according to an analysis by EL PAÍS. They combine their work in public hospitals in the region with the management of private clinics. The most striking case is that of Dr. Pedro Jaén, who has set up a network of four clinics and two surgery centers in the capital, where 89 people work, including 17 of the 27 doctors under his supervision in the Hospital's dermatology department. Ramon y Cajal. The other five manage teams of between four and ten health workers in their clinics. As for the other heads of service, many also participate in paid healthcare. They hold management positions in large private hospitals or consult independently. In total, at least 23 of the 28 combine public and private practice, according to the analysis of open sources and the Commercial Registry made by this newspaper. This coexistence occurs in a specialty with a serious saturation problem. Dermatology is the area with the most patients on the waiting list in Madrid's public health system – 105,329, that is, almost one in seven, in a system with more than 30 branches. The situation raises a transcendent question that affects not only dermatology: does the dual activity of these doctors harm public service? More information This question generates discomfort in a group that usually sees private practice as an opportunity to improve their income. Combining public activity with private activity is legal in Spain and most advanced countries and some believe that it is utopian to introduce exclusivity, because it would lead to doctors' strikes. However, the debate on the possible harms of double practice is relevant at a time of growing weight of the payment market: 40% of Madrid residents already have private health insurance, six points more than in 2019, which makes This region is number one for this sector. Many believe that, due to this personal interest of doctors, a practice that weakens public service has been normalized. And some speak from direct experience, like Sergio García Vicente, a doctor who has been a manager of public and private hospitals in the Valencia region. He warns that he observed a clear conflict of interest for years. “This issue hurts me a lot because the doctor who has this double practice ends up damaging the public system,” says García Vicente, member of the Health Economics Association. “Where are you going to earn the most? In the end you end up quitting your duties in the public service.” Another case of a doctor who combined both activities and ended up denouncing the harm of this practice is the English cardiologist John Dean. In 2015, he caused controversy by writing an opinion article in the British Medical Journal in which he warned that it was immoral to hold both jobs. Dean's arguments, outlined in a recent article by economists Ariadna García Prado and Paula González for the Spanish Society of Public Health and Health Administration, revolved around the perverse incentives previously identified by other experts: professionals can avoid tasks or put little effort in their performance (after hours of work in the private sector), they can strategically increase the waiting list so that more patients are willing to pay for private treatment, or they can refer private patients to the public sector to perform specific tests that result onerous for private clinics. Dean explained that his conscience did not allow him to continue combining both activities. “As much as I tried to live up to my own ethical and moral standards, I couldn't get it out of my head that I was involved in a business where the conduct of some was so dishonest that it bordered on criminal: the greedy taking advantage of the needy.” On the sidelines Whether this practice corrupts or not, such long working hours can harm the quality of care, which would lead to situations in which errors are made, both in diagnosis and medication. Bosses are supposed to work their shift in public hospitals between eight in the morning and three in the afternoon. Data analyzed by this newspaper suggests that some hospitals with business bosses tend to perform very poorly. Three stand out for their performance well below average. In the list of the 28 hospitals, the average number of patients seen by a Sermas dermatologist was 3,158 patients in 2023. The penultimate hospital in that ranking is Clínico San Carlos (2,046), whose dermatology unit is directed by Eduardo López Bran , owner of the Imema clinic. According to another parameter, the days a patient waits, the average of the 28 hospitals in September was 85 days. The worst hospital was the Ramón y Cajal (261 days on average), which is directed by Pedro Jaén, the founder and director of Grupo Pedro Jaén SA; and the second to last was La Paz (166 days), directed by Pedro Herranz Pinto, who manages two medical businesses; Láser Médica Segovia and HBN 39 Especialidades Médicas. The other three business leaders are Pablo de la Cueva, from Infanta Leonor (Vallecas), who owns Dermacue (he is sixth in line in productivity and tenth in line in average waiting); José Luis López Estebaranz, from the Hospital Fundación de Alcorcón, founder and director of DermoMedic Center (it is the tenth worst in productivity and has good average delay data, the seventh best) and Agustina Segurado, head of the Hospital del Sureste (Arganda), and owner of Sclinic (she has the most decent numbers of the entrepreneurs: ninth best in productivity and eighth best in average delay). These six entrepreneurs run clinics with a team of doctors at their command. By far, the largest company is that of Pedro Jaén, who manages 77 doctors and invoices 17 million euros per year. The clinics are usually found in wealthy areas of Madrid such as Salamanca or Chamartín.
Escape to private
The general situation of the specialty has worsened much since the shock of the pandemic. The total average delay in the 28 Madrid hospitals was 37 days in 2019 and is now 85 days. In all of Spain it is the second worst specialty in terms of average waiting time, 118 days, only surpassed by neurology (125 days). Experts say this is partly due to an increased concern about spots and moles with carcinogenic potential. At the same time, the aesthetics boom has continued, which represents a very lucrative private business opportunity for these professionals. More information The data collected by EL PAÍS suggests a combined practice of 82% in dermatology in Madrid, much higher than the average in Spain. The Collegiate Medical Organization reports that 37% of its members combine both areas, according to the data it compiles from the medical associations of Spain. However, this percentage may be lower than reality. The College of Physicians of Madrid is reforming its data collection system because until now the members marked one of two boxes on the form: private or public practice. Other statistics show that competition from the private network to attract healthcare workers has intensified. the public. Private employment of specialist doctors was around 30% of the total in 2021, with an increase of 7% since 2018, compared to the drop in public employment of 1.7%, according to a report prepared for the Ministry of Health. The power of attraction is so strong that the scientific society of the field, the Spanish Academy of Dermatology and Venereology, warns that more and more dermatologists choose to dedicate themselves only to private practice. “It is difficult to retain professionals, especially in regional hospitals,” says José Manuel Carrascosa, vice president of this association. “For many, public dermatology is no longer attractive.” According to the report Job offer and demand in Spain, prepared by Adecco and Infoempleo, dermatologists are the best paid doctors in Spain, with an average salary of 72,122 gross euros per year.María Cordón, member of free practice in the College of Physicians of Madrid, sees the case of dermatology as a clear example of the displacement of doctors from the public to the private sector. He also observes that the phenomenon of the doctor-entrepreneur is growing, driven by greater demand from the population and by the discomfort of professionals with health insurance, who resist updating the rates they are paid per consultation. “It has been months since we created a private table at the College and I was surprised that there are many businessmen,” says Cordón. She founded a general clinic, Blue Healthcare, in 2019. Cordón does not believe that compatibility corrupts doctors and defends the professionalism of the heads of services who combine the two practices “at the cost of staying up until eight or nine at night spending private consultation.” To reduce public waiting lists, she advocates for more public-private cooperation, for example through referrals to private centers of patients in line. García Vicente defends that the solution to avoid corruption is more control. “The governors must carry out audit work that unfortunately is not done, because preference is given to the well-being of these doctors and social peace within the hospital over the patients, who in the end are the ones who end up paying the price.” Do you have more information? Write to the authors at fpeinado@BitcoinDynamic.es and njimenez@formacion.BitcoinDynamic.esSubscribe here to our newsletter about Madrid, which is published every Tuesday and Friday.