Integration of mental health comorbidity in medical specialty programs in 20 countries.

METHODS: A systematic analysis was performed of the medical specialization academic programs of 20 different countries to establish which medical specialties take into account mental health issues in the specialty curricular design and which mental health content these programs address. The criteria that were explored in the educational programs include: 1) name of the medical specialties that take into account mental health content in curriculum design, 2) name of the mental health issues addressed by these programs. After independent review and data extraction, paired investigators compared the findings and reached consensus on all discrepancies before the final presentation of the data. Descriptive statistics evaluated the frequency of the data presented. RESULTS: Internal medicine, family medicine, neurology, pediatrics and geriatrics were the specialties that included mental health topics in their programs. In four countries: Bangladesh, Serbia, the Netherlands and France, 50%of all graduate specialty training programs include mental health content. In ten countries: Germany, Sweden, the United Kingdom, Mexico, Belgium, India, Russia, Canada, Israel and Spain, between 20% and 49% of all graduate specialty training programs include mental health content. In six countries - Brazil, Chile, Colombia, Croatia, Kenya, and the United States-less than 20% of all graduate specialty training programs include mental health content. DISCUSSION: The proposal that we have made in this article should be taken into account by decision-makers, in order to complement the different postgraduate training programs with mental health issues that are frequently present with other physical symptoms. It is not our intention that the different specialists know how to treat psychiatric comorbidities, but rather pay attention to their existence and implications in the diagnosis, evolution and prognosis of many other diseases. The current fragmentation of medicine into ever finer specialties makes the management of comorbidity ever more difficult: a reorientation of post- graduate training might improve the situation.

Los médicos especialistas en México.

INTRODUCCIÓN: No hay datos recientes en México sobre el estado de los médicos especialistas que permitan diseñar políticas de formación y empleo de los recursos humanos para la salud. OBJETIVO: Analizar el estado actual de los médicos especialistas en México: número, distribución (geográfica, por sexo y especialidad), vigencia de la certificación (por sexo y especialidad) y tasa de especialistas por 100 000 habitantes. MÉTODO: estudio transversal descriptivo. Se consultaron múltiples fuentes disponibles en México: consejos, asociaciones, colegios, instituciones hospitalarias, universidades y otros. RESULTADOS: Se contabilizaron 147 910 especialistas para una población de 123 518 272 habitantes; 69 % contaba con certificación vigente de la especialidad. Se obtuvo una tasa de 119 especialistas por 100 000 habitantes; 54.2 % se encontraba en la Ciudad de México, Estado México, Jalisco y Nuevo León. En promedio había 1.7 especialistas varones por cada mujer. CONCLUSIONES: El número de especialistas es inferior al recomendado internacionalmente e insuficiente para cubrir las necesidades en salud del país. La distribución por género está cambiando hacia una más equitativa. Los especialistas están agrupados mayormente en zonas urbanas. Es el primer censo de especialistas con base en el número comprobable de médicos, que permitirá el diseño de políticas de planificación de recursos humanos en salud. INTRODUCTION: There are no recent data in Mexico about the state of medical specialists that allow the design of policies for training and use of human resources for health. OBJECTIVE: To analyze the current state of medical specialists in Mexico: number, distribution (geographical, by gender and specialty), certification validity (by gender and specialty) and the rate of specialists per 100 000 population. METHOD: Cross-sectional, descriptive study. Multiple sources available in Mexico were consulted: councils, associations, schools, hospital institutions, universities, and others. RESULTS: A total of 147,910 specialists were counted for a total population of 123,518,272 inhabitants; 69 % had current specialty certification. A rate of 119 specialists per 100 000 population was obtained; 54.2 % are in Mexico City and in the States of Mexico, Jalisco and Nuevo León. On average, there are 1.7 male specialists per female specialist. CONCLUSIONS: The number of specialists is lower than that internationally recommended and insufficient to cover the health needs of the country. Gender distribution is shifting towards a more equitable one. Specialists are mainly grouped in urban areas. This is the first census of specialists based on total verifiable number of physicians, which will allow the design of policies for human resources planning in health.