“This year is the last; if not, I leave it.” “I’m letting life go by.” “It is impossible”. These are some of the phrases that echoed in the head of 29-year-old Claudia Zumel for the past four years, in which she devoted time, effort and perseverance to obtain a position as an internal psychologist resident (PIR). And when he was examined for the fourth time, he succeeded. “I felt an immense flood of emotions, and I started to cry,” the young woman confided to La Vanguardia.
This Barcelona native has this year obtained one of the 247 places that the Ministry of Health announced, to which 3,929 people aspired. This implies that only 6% manage to access this training in the public system. For this reason, it is not surprising that many aspirants define the exam as an “impossible ascent” and choose to give up and look for other ways to practice.
“There comes a time when preparation becomes a habit within the routine. I felt that it was an end in itself”, says the young woman. Frustration and disappointment have lived with her these years. She often considered letting it be, but at the same time it became a “personal challenge” that pushed her to move forward. It also helped that, year after year, he shortened distances and reduced the number of errors in the 200 questions (plus ten reserves) that make up the exam.
Despite the fact that the places for the PIR exam, which is taken on the same day as the other specialties, have doubled in the last ten years, professionals say that it is still not enough. In fact, clinical psychology has the worst ratio of places per applicant among all health exams.
“We have been anticipating the need for many years; first of all, that more places are accredited, and secondly, that all are offered, since in some communities this is sometimes not the case”, explains Gabriel Ródenas, clinical psychologist and member of the Spanish Society of Clinical Psychology ( SEPC -Anpir) for Andalusia. “To guarantee minimum structural conditions for clinical psychologists, around 422 PIR places are needed annually”.
The lack of places has given rise to movements like
All this time, Claudia has combined dedication to the PIR with a full-time job. “This has been the most difficult. But maybe it also helped me stay focused and calm.” After eight hours of work, he would rest a bit and immerse himself in psychology textbooks for four hours until it was time to go to bed. “This year I have tried to be more compassionate with myself, and to recognize the effort I put in and that we sometimes forget during the preparation.”
Although the road has been complicated, he has had the support of his family and, especially, his father, who is also a psychologist and doctor. “It has been and is a fundamental support in my life, in my preparation and in my short career. Being able to debate with him and analyze questions together has made things a lot easier for me.”
The lives of many opponents also revolve around the links that are created through platforms like WhatsApp. “It is a very supportive opposition, in which a lot of material is shared. I admire all the women who stay at the gates of the square every year. And I would tell them that, if they have the energy, don’t stop trying.”
While thousands of people aspire every year to train in clinical psychology, the lack of specialists in health centers has exposed the shortcomings of the system with overwhelmed professionals, eternal waiting lists and the increasing periodicity between visits . At the same time, mental disorders are increasingly prevalent, especially among children and young people, and the country has a record suicide rate, surpassing the barrier of 4,000 deaths in the last year.
Beatriz Torres knows this saturation intimately. She is a clinical psychologist, after obtaining a position in 2006, and works at the Príncipe de Asturias hospital in Alcalá de Henares. “Public centers in the Community of Madrid have had waiting lists for eight months, and the frequency of visits is between three and four months. Would we accept these times with cancer patients who needed chemotherapy? It would seem unthinkable, cruel and deficient, but in mental health it is normalized”.
And Ródenas, a clinical psychologist in Andalusia, adds: “To be able to apply treatments, time and space are essential, but we can’t if they give a person an appointment four times a year.” The lack of specialists also causes an overload of work. “I managed to treat 14 people in one day with sessions of 30 minutes per patient”, says Torres, when he worked in another centre.
There are a large number of professionals who, even if they have been trained in public health, later work in the private sector. On the one hand, for the places that are offered, that is to say, the ability to replace and lose loyalty of residents is “much to be improved”.
And on the other, for the duration of the contracts. “We string together temporary contracts of a few months, which make you think about the vital project. And, in spite of everything, we are aware that there are clinical psychology positions in primary care that are not filled”, reports Ródenas. “There are people who emigrate, who want to return to Andalusia, but other communities offer them more stability and job guarantees.”
Since she assumed the portfolio, the Minister of Health, Mónica García, has expressed that she intends to double the number of places during the legislature. The General Council of Psychology of Spain (COP) assessed the proposal as “highly positive”, “although more would still be needed to cover the demand”. Despite everything, the COP warned if the autonomous communities have enough accredited teaching units to be able to attend to this increase.
Claudia will start her residency in a few months with the vocation and reason that led her to study this profession, however “naïve it may seem”: “To help people”. “Little by little, my motivation developed into something more political.”
The young woman believes that psychology must also be a tool for social change and to avoid adapting people to normative contexts that can perpetuate systems of oppression and inequality. In this line, the future resident says that the disorders must go hand in hand with the context because it is the context that causes it most of the times that we suffer from these disorders.
