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Médico especialista en nefrología (Spain)

  • Proportionality information

    1. Have you examined whether the requirements under your national legal system are
    directly or indirectly discriminatory on the basis of nationality or residence?
       No, the requirements laid down in our national legislation are absolutely non-discriminatory, either in terms of nationality or in terms of residence. They are in line with the principles of freedom of establishment, freedom of movement and freedom to provide services stated in the Directive 93/16/EEC, modified by the Directive 2005/36/EC, and they are protected by our own national laws (Spanish Constitution, Law of Professional Associations and Codes of Medical Ethics and Deontology).

    2. Which of the following overriding reasons relating to the general interest justifies the measure(s)?
    • Public health

    3. What specific risks or benefits have you identified that your measure(s) is designed to, respectively, minimise or maximise?

       Please try to be specific in describing the nature of the risks/benefits you have identified
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. Wherever possible please include evidence.

       The professional qualification required, the official training programme to achieve it and the registration in the professional association guarantee professional competence and a reliable good-quality medical service. The registration of practicing doctors is a guarantee, as well as the professional’s observance of ethical standards and medical ethics. Other important aspects to keep in mind are the professional’s accountability and autonomy and the importance of responsible decision-taking by duly informed patients; medical practice based on evidence and subject to the Lex Artis ad Hoc principle; efficiency and accountability in the use of resources and technology available; professional corporations’ code of transparency and good governance.

    4. How specifically do your measures operate to minimise the risk(s) or maximise the benefit(s) identified in question 3?

       When addressing this question please try to explain how the measures prevent the risks or guarantee the benefits.

       Registration in the medical professional association guarantees: secure access to the register of qualifications of the Ministry of Education, Culture and Sport through an automated  search engine; electronic certification of the professional’s identity; public consultation of registered doctors, area of expertise and status of professional  qualification; periodic competence validation; continuing medical training; secure and reliable electronic check code in private medical prescriptions; use of the IMI system for queries regarding disciplinary matters or professional disqualifications; treatment of Doctors suffering from psychological pathologies or addictive disorders (PAIME Programme of the  Medical Professional Body) providing complete confidentiality

    5. In so far as you are able, please provide information that you have gathered regarding the concrete effects of the measure(s).

       For example, through impact assessments or information gathered during implementation or review of a measure. Member States who have recently undergone reforms may in particular be able to contribute helpfully to this field. Where you are able to provide cost-benefit analyses this would be particularly valuable.
       Information on whether the measures indeed successfully prevented risks from being realised (e.g. the number of sanctions imposed, a drop in transgressions since the measure was introduced or consequences from previous modifications of the regulation) would equally be helpful.
       Where you have selected more than one overriding reason relating to the general interest in question 2 please be sure to address each of these in your response. You may also wish to include evidence on consumer satisfaction or other measurements of the impact.

        The  training activities organised by 52 Professional Associations of Doctors in 2013 were offered online, face to face or through a blended learning methodology, amounting to 838 courses consisting of 1,592.68 credits, attended by 28,122 students. From 2005 to 2015, there have been 62 disqualifications of registered doctors. Since its beginning in 1998 till 2014, the number of doctors involved in the PAIME programme (Comprehensive Care Programme for the Sick Doctor), organised by the Medical Professional Body for the social and professional reintegration of the sick doctor, has been 3,810 with a percentage of reintegration exceeding 90 %.

    6. Is the general interest objective you indicated in question 2 pursued in a consistent and systematic manner?.

       In approaching your response to this question please consider examples where you have addressed similar risks for comparable professions, not necessarily within the same sector. Is the approach you have adopted in this particular profession comparable or distinct from such similar cases and why?

       Yes. To ensure a safe, high-quality and appropriate professional practice is the ultimate aim, as well as a guarantee for the users of the health care system. Health administrations and Medical Professional Associations have to provide for their enforcement. Only doctors, dentists and podiatrists can determine, evaluate, diagnose and treat diseases, as an indissoluble part of their university training; prescription is an expression of that diagnostic activity. The Supreme Court has outlined it as follows:  “The core of the professional competence that defines and differentiates the medical profession can be considered as characterized by the ability to determine an illness or mental pathology and then their cure." This conclusion can be drawn from the above mentioned case-law doctrine of the actual professional’s capacity, as well as from the principles that inspire regulatory provisions or even from the very nature of medical profession.

    7. Please explain in how far the degree of complexity or the nature of the activities
    which are reserved justify that these activities can be exclusively performed by professionals possessing a specific professional qualification?

       For example: when the tasks are essentially of a straightforward nature (such as preparing and printing pay slips etc.), or involve essentially the execution of instructions, specific professional aptitudes should not be required.

       Qualified, regulated professions with reserved activities, like the medical profession, have their own guarantee scheme and justification in a competent, high-quality exercise with full attention to the public interest and to the safety of their patients. A doctor is a highly qualified professional whose skills require proper regulated training and education, subject to legal training programmes. To exercise a specific profession, a prior qualification is required and necessary. This is the first principle of individual responsibility of the professional, as well as of the Medical Professional Body in which (s)he has to be integrated for the purpose of guaranteeing the interest and safety of citizens. It is also essential to assure that the services provided by that professional meet all the quantitative and qualitative requirements  regarding his/her knowledge, training and competency.

    8. Where you have indicated several measures in place in the screening tab,
    have you reviewed the cumulative effect of all these measures on professional activities?

       If not, why not?
       If yes, please outline for us how you approached assessing this issue as well as the results and conclusions or any learning you drew from this. Where possible please include evidence.

       Yes, all the necessary measures are individually and globally applied to the environment of professional activities

    9. Have you considered the use of alternative mechanisms to achieve your objective(s)?
    • Other, please specify

       Please briefly explain. Where you have selected more than one option, please be sure to address each of these in your response.

       The system in place seems consistent and reliable

    10. Conclusion

       Following your internal examination of this regulated profession, which of the following have you concluded?

    •    Improve current system (simplify guidance, remove burdensome aspects etc.)

       Explain where relevant:

       Actions should be simplified to ensure that specific requirements are met: a qualification conforming to Law, a reliable professional register, a test or an additional training programme if needed, or certification of language knowledge, where appropriate. On the whole, the current system could be maintained but it would be desirable to have a swifter process, as well as to implement flexible protocols while ensuring that the necessary requirements are fulfilled in order to enhance competences.

    11. Any other comments?

    No further comments

