Orthopaedic surgery in SPAIN - UEMS

Orthopaedic Orthopaedic surgery in SPAINsurgery in SPAIN

UEMS Orthopaedic SectionUEMS Orthopaedic Section2008 2nd annual meeting2008 2nd annual meeting

Edimburgh, September 27thEdimburgh, September 27th

Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN►Spain 2008Spain 2008►Health careHealth care►Orthopaedic surgeryOrthopaedic surgery►SECOT (Sociedad Española de Cirugía SECOT (Sociedad Española de Cirugía

Ortopédica y Traumatología)Ortopédica y Traumatología)►Orthopaedic trainingOrthopaedic training

Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN►Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y

Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training

Spain 2008Spain 2008►45.000.000 people45.000.000 people►Aprox. 500.000 KmAprox. 500.000 Km2 2 (2nd in Europe) (2nd in Europe)►Weather:Weather:

Atlantic (north)Atlantic (north)

Mediterranean (east, south)Mediterranean (east, south)

Continental (interior)Continental (interior)

►European Comunity since 1986European Comunity since 1986►Euro since 2002Euro since 2002►GNP: 80-90% “euro-zone”GNP: 80-90% “euro-zone”

Spain 2008Spain 2008► Constitutional Constitutional

monarchymonarchy

AndalucíaAndalucía

AragónAragón

AsturiasAsturias

CantabriaCantabria

Castilla La ManchaCastilla La Mancha

Castilla-LeónCastilla-León

CataluñaCataluña

ExtremaduraExtremadura

► 18 autonomic regions 18 autonomic regions (regional governments (regional governments and parlaments):and parlaments):

GaliciaGalicia

La RiojaLa Rioja

MadridMadrid

MurciaMurcia

NavarraNavarra

País VascoPaís Vasco

ValenciaValencia

Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008

►Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y

Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training

Health careHealth care► Public medicine Public medicine

National Health SystemNational Health System►Universal coverageUniversal coverage►Paid with taxesPaid with taxes►Free assistance & free medicines for retiredFree assistance & free medicines for retired

► Private medicinePrivate medicine Urban areasUrban areas Aprox. 20% populationAprox. 20% population Mostly HMOMostly HMO

Health careHealth care►Public medicine: National Health SystemPublic medicine: National Health System

Regional organization Regional organization ►““Consejerías de sanidad” (Health Regional Consejerías de sanidad” (Health Regional

Councils)Councils) Supra-regional control Supra-regional control

►Health MinisteryHealth Ministery

►Pros: competence among regions promotes Pros: competence among regions promotes improvementimprovement

►Contras: Contras: Difficulties in coordination among regionsDifficulties in coordination among regions Division of economical fundsDivision of economical funds

Health careHealth care►National Health SystemNational Health System

Primary medicine: Primary medicine: ►GPs GPs ►Health CentersHealth Centers

Specialized medicine: Specialized medicine: ►Hospitals Hospitals ►Out-patient facilitiesOut-patient facilities

Health careHealth care►HospitalsHospitals

University hospitals University hospitals ►All DepartmentsAll Departments►500-2000 beds500-2000 beds

Small hospitalsSmall hospitals►““High demand” specialitiesHigh demand” specialities►100-500 beds 100-500 beds

Health careHealth care►HospitalsHospitals

Hyerarchic organization:Hyerarchic organization:►Physicians:Physicians:

Chief of DepartmentChief of Department Chiefs of sections / unitsChiefs of sections / units Members of staffMembers of staff ResidentsResidents

►NursesNurses►Nurse-assistantsNurse-assistants

Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care

►Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y

Traumatología)Traumatología)► Orthopaedic trainingOrthopaedic training

Orthopaedic surgeryOrthopaedic surgery►All pathology in limbs and spineAll pathology in limbs and spine

Reumathologists: Reumathologists: ►Treatment of inflammatory pathologyTreatment of inflammatory pathology

Rehabilitation physicians: Rehabilitation physicians: ►direction of physiotherapydirection of physiotherapy

Vascular surgeons: Vascular surgeons: ►surgical treatment of vascular pathology surgical treatment of vascular pathology

Orthopaedic surgeryOrthopaedic surgery►All pathology in limbs and spineAll pathology in limbs and spine

Traumatic / non traumaticTraumatic / non traumatic Diagnostics / Treatment / Follow-upDiagnostics / Treatment / Follow-up Surgical / Medical / Physical therapy / Surgical / Medical / Physical therapy /

ConservativeConservative

Orthopaedic surgeryOrthopaedic surgery► Aprox 5.000 physicians practising Aprox 5.000 physicians practising

orthopaedic surgery orthopaedic surgery ►(not all (not all officialofficial title) title)

► Typical weekly work-scheduleTypical weekly work-schedule Surgery: 1-2 weekly sessions (7 hours)Surgery: 1-2 weekly sessions (7 hours) Out-patient clinic: 2-4 weekly sessionsOut-patient clinic: 2-4 weekly sessions

►1-2 highly specialised (hospital)1-2 highly specialised (hospital)►1-2 low specialisation (peripheral facilities)1-2 low specialisation (peripheral facilities)

Emergency: 1 weekly session (24 hours)Emergency: 1 weekly session (24 hours)

Orthopaedic surgeryOrthopaedic surgery NO official sub-specialitiesNO official sub-specialities In practical setting: areas of special In practical setting: areas of special

interestinterest►Hand surgeryHand surgery►Spine surgerySpine surgery►Shoulder / upper limbShoulder / upper limb►Arthroscopy / sports / soft kneeArthroscopy / sports / soft knee►Arthroplasty / lower limb reconstructiveArthroplasty / lower limb reconstructive►TraumaTrauma

Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery

►SECOT (Sociedad Española SECOT (Sociedad Española de Cirugía Ortopédica y de Cirugía Ortopédica y Traumatología)Traumatología)

► Orthopaedic trainingOrthopaedic training

SECOTSECOT►1) Members1) Members►2) Relations2) Relations►3) Organization3) Organization►4) Activities4) Activities

SECOTSECOT►1) MEMBERS1) MEMBERS

Aprox 4000 membersAprox 4000 members►(not all with official title)(not all with official title)►2000-2500 certified orthopaedic surgeons2000-2500 certified orthopaedic surgeons

Full-membersFull-members►500 residents500 residents

Associate membersAssociate members►Aprox 1000 non-certified physicians practising Aprox 1000 non-certified physicians practising

orthopaedic surgeryorthopaedic surgery Associate membersAssociate members

►Honour membersHonour members Retired full-membersRetired full-members

SECOTSECOT►2) RELATIONS2) RELATIONS

Internal Study Groups (variables)Internal Study Groups (variables) Infection, spine, pain, TED, dynamic OS, …Infection, spine, pain, TED, dynamic OS, …

Fraternal relationFraternal relation►Spanish sub-speciality societiesSpanish sub-speciality societies

Spine, Shoulder&Elbow, Hand, Hip, Knee, Spine, Shoulder&Elbow, Hand, Hip, Knee, Arthroscopy, Foot&Ankle, Pediatrics,…Arthroscopy, Foot&Ankle, Pediatrics,…

►Spanish regional societies Spanish regional societies

SECOTSECOT►2) RELATIONS2) RELATIONS

Member of EFORT & UEMSMember of EFORT & UEMS

Special relations:Special relations:►AAOSAAOS

crossed symposiacrossed symposia shared bookshared book

►Latin America societiesLatin America societies crossed symposia crossed symposia

SECOTSECOT►3) ORGANIZATION3) ORGANIZATION

General AssemblyGeneral Assembly

Executive CommitteeExecutive Committee

SenateSenate

SECOTSECOT►3) ORGANIZATION3) ORGANIZATION

General AssemblyGeneral Assembly►Once yearly, in Annual CongressOnce yearly, in Annual Congress►Direct voteDirect vote

Election of Vice-President (future President) every Election of Vice-President (future President) every two yearstwo years

Election of Journal editorElection of Journal editor Legislative Legislative

SECOTSECOT►3) ORGANIZATION3) ORGANIZATION

Executive CommitteeExecutive Committee►1 President (elected 2 years before)1 President (elected 2 years before)►1 elected Vice-President1 elected Vice-President

elected by General Assembly every 2 yearselected by General Assembly every 2 years►1 Past-President1 Past-President►Treasurer, General Secretary, Members Treasurer, General Secretary, Members

number variablenumber variable Elected by President Elected by President Head of Committees: Education, Publications, Head of Committees: Education, Publications,

Annual Congress, Associated Members, Legal issuesAnnual Congress, Associated Members, Legal issues

SECOTSECOT►3) ORGANIZATION3) ORGANIZATION

SenateSenate►Past-PresidentsPast-Presidents►Counseling activity for PresidentCounseling activity for President

SECOTSECOT►4) ACTIVITIES4) ACTIVITIES

Annual CongressAnnual Congress Annual Basic CourseAnnual Basic Course JournalJournal PublicationsPublications Grants & PrizesGrants & Prizes

SECOTSECOT► 4) ACTIVITIES4) ACTIVITIES

Annual CongressAnnual Congress►3 full days / aprox 2000 participants3 full days / aprox 2000 participants►Rotating location: Madrid / Barcelona / Other Rotating location: Madrid / Barcelona / Other ►End of September / Beginning of OctoberEnd of September / Beginning of October►Educational:Educational:

Official Themes Official Themes Instructional CoursesInstructional Courses Industry symposiaIndustry symposia

►Research:Research: Free papers Free papers Posters Posters

SECOTSECOT►4) ACTIVITIES4) ACTIVITIES

Annual Basic CourseAnnual Basic Course►2-3 days / 150-200 participants2-3 days / 150-200 participants►Variable location all along country Variable location all along country ►JuneJune►Basic Monographic Course for ResidentsBasic Monographic Course for Residents

SECOTSECOT►4) ACTIVITIES4) ACTIVITIES

JournalJournal►““Revista española de Ortopedia y Revista española de Ortopedia y

Traumatología”Traumatología”►Elsevier / MassonElsevier / Masson►6 issues / year6 issues / year►Editor in chief elected by General AssemblyEditor in chief elected by General Assembly

SECOTSECOT►4) ACTIVITIES4) ACTIVITIES

Publications (Books)Publications (Books)►Instructional CoursesInstructional Courses►““Up-to dates”Up-to dates”►MonographiesMonographies►Hand-bookHand-book►Annual Case-Report BookAnnual Case-Report Book►Cross-publication with other societiesCross-publication with other societies

SECOTSECOT►4) ACTIVITIES4) ACTIVITIES

Grants Grants ►Congress & Basic GrantsCongress & Basic Grants►Travelling grantsTravelling grants►Foreign & National visitsForeign & National visits►Research projectsResearch projects

PrizesPrizes►Best Basic & Clinical research studyBest Basic & Clinical research study►Best published paperBest published paper

Orthopaedic surgery in SPAINOrthopaedic surgery in SPAIN► Spain 2008Spain 2008► Health careHealth care► Orthopaedic surgeryOrthopaedic surgery► SECOT (Sociedad Española de Cirugía Ortopédica y SECOT (Sociedad Española de Cirugía Ortopédica y

Traumatología)Traumatología)

►Orthopaedic trainingOrthopaedic training

Orthopaedic trainingOrthopaedic training►1) Access1) Access►2) General organization2) General organization►3) Activities3) Activities►4) Control of training4) Control of training►5) Control of training centers5) Control of training centers

Orthopaedic trainingOrthopaedic training►1) ACCESS1) ACCESS

Medical degreeMedical degree National exam National exam

►250 MCQ about medicine250 MCQ about medicine Ranking according to exam + Ranking according to exam +

qualifications in Medical Schoolqualifications in Medical School Election by rankingElection by ranking

►Medical specialityMedical speciality►HospitalHospital

Orthopaedic trainingOrthopaedic training►2) 2) GENERAL ORGANIZATIONGENERAL ORGANIZATION

Five yearsFive years 175 residents / year175 residents / year 50% female / male (nowadays)50% female / male (nowadays) Public hospitalsPublic hospitals Laboral contract, worker’s rightsLaboral contract, worker’s rights

►35 hours/week + hours / days on duty 35 hours/week + hours / days on duty Difficulties with EWDT because of days on dutyDifficulties with EWDT because of days on duty

►Free day after 24h on duty (not always possible)Free day after 24h on duty (not always possible)

Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES

RotationsRotations

►External:External: Compulsory: Anaesthesia, Plastic Surgery, VascularCompulsory: Anaesthesia, Plastic Surgery, Vascular Optative: most surgical, Rehabilitation, RheumatologyOptative: most surgical, Rehabilitation, Rheumatology

►Internal:Internal: Compulsory: PediatricsCompulsory: Pediatrics Advisable: tumours, hand, arthroscopy, spineAdvisable: tumours, hand, arthroscopy, spine

Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES

On dutyOn duty►Periods of 24 hours on dutyPeriods of 24 hours on duty►From 4 to 8 days / monthFrom 4 to 8 days / month►Heavy work in Emergency DepartmentHeavy work in Emergency Department►Light work in hospitalization wardLight work in hospitalization ward►Most hospitals: first callMost hospitals: first call

Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES

SurgerySurgery►Progressive responsibilityProgressive responsibility►2nd assistant / 1st assistant / supervised 2nd assistant / 1st assistant / supervised

surgeonsurgeon►7 hours / session7 hours / session►1 - 4 sessions / week1 - 4 sessions / week►NO compulsory number / type of surgeriesNO compulsory number / type of surgeries

Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES

Out-patient officeOut-patient office►Assistant / assistedAssistant / assisted►In practice, irregular In practice, irregular ►No compulsoryNo compulsory►No in many hospitalsNo in many hospitals

Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES

In-hospital patientsIn-hospital patients►Variable organization according to Variable organization according to

DepartmentsDepartments►Clinical & burocratic tasksClinical & burocratic tasks►Main medical worker for hospitalization ward Main medical worker for hospitalization ward

Orthopaedic trainingOrthopaedic training►3) ACTIVITIES3) ACTIVITIES

Theoretical teachingTheoretical teaching►Daily / weekly / monthly sessionsDaily / weekly / monthly sessions►Sessions of 15 min – 2 hoursSessions of 15 min – 2 hours►Irregular, great variabilityIrregular, great variability►Types of sessions:Types of sessions:

Emergency cases / Surgical cases / Hospitalization ward / Emergency cases / Surgical cases / Hospitalization ward / Bibliography / Monographics / Radiological / HistologicalBibliography / Monographics / Radiological / Histological

Orthopaedic trainingOrthopaedic training►4) Control of training4) Control of training

Head of teaching: Head of DepartmentHead of teaching: Head of Department TutorTutor LogbookLogbook Continuous evaluationContinuous evaluation Annual evaluation (logbook + staff opinion)Annual evaluation (logbook + staff opinion) NO compulsory examsNO compulsory exams NO intermediate examsNO intermediate exams Voluntary final exam (launching)Voluntary final exam (launching)

Orthopaedic trainingOrthopaedic training►5) Control of training centers5) Control of training centers

Ministery of HealthMinistery of Health Periodical auditsPeriodical audits Control of logbooksControl of logbooks Beds / facilities / surgical activity / out-Beds / facilities / surgical activity / out-

patient activity / library patient activity / library

Thank youThank you