MEDICAL SUBSPECIALTIES IN CHILE - CURRENT STATUS

There is no reliable registry of medical subspecialists in Chile. Acco rding to the records of the Autonomous National Corporation for Certif ication of Medical Specialties (CONACEM), the largest number of certif ications is in internal medicine (n=681), followed by cardiology (n=15 3), respiratory medicine (n=106), gastroenterology (n=93), endocrinolo gy (n=77), rheumatology (n=55), hematology (n=50) nephrology (n=50), a nd infectious diseases (n=31). Over 55% of those certified in internal medicine and 70% of those certified in medical subspecialties (except nephrology) live in the metropolitan area of Santiago. Almost 80% of university-trained internists have received their training at the Univ ersity of Chile (1952-1995), whereas 52% of university-trained subspec ialists have been trained at the Catholic University of Chile. A sizea ble number of nonofficial specialist-training programs are conducted a t some universities at variance with their own official training polic ies. In internal medicine, a larger number of specialists have been tr ained by the universities than are certified by CONACEM, whereas the c onverse is true for medical subspecialists. More than 80% of the inter nists in Chile work for the Ministry of Health, who cares for 70% of t he country's population, The best internist: population ratio is in Ar ica and Valdivia, and the poorest one in Arauco and in Vina del Mar/Qu illota. According to estimations done by the Santiago Medical Society (Chilean Society of Internal Medicine) and its subspecialty affiliate societies, an adequate proportion of internists would be 1 for every 1 0,000 inhabitants, and for subspecialists, 1 for every 100,000 inhibit ants. More information is needed about the ideal number of specialists and subspecialists required, and about their ideal distribution throu ghout the country. CONACEM needs to be strengthened, the universities should be able to certify non-university training centers, and the mig ration of subspecialists out of Santiago should be encouraged.