The long road to emergency medicine: from frustration to success | Legal

The long road to emergency medicine: from frustration to success | Legal
The long road to emergency medicine: from frustration to success | Legal

In order to achieve the creation of the Specialty of Emergency Medicine (MUE), it has not only been necessary to put the administration into operation (several times), but also to correct some of its missteps.

A historic day for Spanish healthcare. The BOE has published Royal Decree 610/2024, which creates the new specialty of Emergency Medicine (EUM). The new qualification completes (it was about time!) the catalogue of medical specialties, satisfying a historic demand from professionals and users of the National Health System (NHS) and putting an end to a situation that had been causing dysfunctions in the healthcare system for years. The news has spread like wildfire in the media and Spain has welcomed it with open arms. However, few know the long road traveled.

Specifically, the text improves the map of specialties, adapting it to the European model of primary specialty, facilitating the free provision of services in the European Union (EU) and ending the incomprehensible professional discrimination that Spanish emergency physicians saw suffering compared to their European colleagues. This process has been led by the Spanish Society of Emergency Medicine (SEMES) which, with vision and determination, has achieved an achievement that time will recognize as a great success of the SNS.

Having participated in the legal aspect of this long process, I have learned some of its difficulties and intricacies from which social agents and legal operators can extract important lessons that complete the legal provisions on participation in the development of regulatory standards. And the fact is that, in order to achieve the creation of the MUE specialty, it has not only been necessary to put the administration in motion (several times), but also correct some of their misstepssuch as the improper initial configuration as a specific training area in Royal Decree 639/2014. Or the prior approval of some general regulations, such as Royal Decree 589/2022, which establishes the procedure and criteria for the creation of specialist titles.

In this case, a host of initiatives have been undertaken, including the submission of various non-statutory motions in 2007, 2012, 2017 and 2021. Numerous questions have also been put to members of the Government in various legislatures regarding compliance with the commitments made, parliamentary sessions have been held to expose the true dimension of the problem and actions have been submitted to the Ombudsman and the Directorate-General for the Internal Market of the European Commission.

In addition, the Court has participated in all phases of the regulatory procedures of Royal Decrees 639/2014, 589/2022 and 610/2024. In some cases, with a double-round review by the Council of State, and two judicial proceedings have been processed in which the Supreme Court declared the nullity of Royal Decree 639/2014 and requested the regulation of specialization as a solution to end the violation of fundamental rights.

Law 39/2015 on common administrative procedure deals with the legislative initiative and the power to issue regulations and other provisions, establishing a simple procedure, with precepts (articles 127 to 133) that are apparently clear and concise.

With these expectations, the translation of legal provisions into the complex political, administrative and institutional reality can generate enormous frustrations and failures, since there are circumstances that the law does not contemplate but reality imposes. In the long process of creating the MUE specialty we have seen some of them.

Among others, that the administration is not always a reliable ally, as it is subject to a multitude of tensions and vicissitudes; or that politics often contaminates almost everything (and sometimes, everything). Also that, sometimes, sadly, the last thing that public powers look at is the general interest and that this, in turn, cannot be one thing and its opposite, because when the administration accepts what is requested, it claims that it must regulate and, however, it omits the exercise of the regulatory power, delaying in time the solution to a dysfunctional and harmful situation. Or even that the courts can resolve a case but not the problem, which is a Lampedusian way of ending a process.

And one last lesson, undoubtedly the most important: in a social and democratic State of Law, in an open society, organizations representing professional interests, such as the Spanish Society of Emergency Medicine, have a fundamental and irreplaceable role. as interlocutors of the public authoritiescontributing and promoting regulatory initiatives for progress and social improvement.

It takes a lot of tenacity and strong convictions to maintain, despite setbacks, procedural delays, unfulfilled commitments, changes in government and administrative officials, an initiative such as the creation of the title of specialist doctor in Emergency Medicine.

There are few subjects as directly linked to the well-being of people as health and few issues more intensely necessary than investing in more competent medical teamsbetter trained, more efficient and with better defined professional careers.

It has been rightly said that all’s well that ends well. And now is a good time to congratulate ourselves for that.

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