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Czech doctors resign en masse
World Report
Czech doctors resign en masse Hospitals in the Czech Republic are bracing themselves for service disruptions as thousands of doctors resign in protest over poor working conditions and low pay. Ed Holt reports. Czech health minister Leos Heger has admitted that the government could be forced to use emergency reserve funds to keep hospitals functioning, as thousands of doctors begin to hand in their notices as they demand healthcare reforms and pay rises. Doctors’ unions launched a protest campaign early in 2010 demanding reforms to the health-care system and a three times increase in salaries for doctors, warning that if action was not taken thousands of doctors would resign en masse at the end of the year. Thousands of physicians made good on the threat in the first 2 weeks of December, and unions have claimed as many as 4000 could leave before mid January. At the time of going to press, 3800 doctors had already resigned. Some hospitals say that they are at risk of losing up to 70% of their staff, and the health minister has admitted that even emergency surgery could be impossible to undertake. The health ministry remains adamant that it does not have the funds to meet the doctors’ wage demands, but union leaders say that doctors have been left with no choice but to take their drastic course of action. Jana Vedralova, deputy chair of the Czech Doctors’ Union (LOK), which has organised the doctors’ protests, told The Lancet: “We don’t want to destroy the health system. We want to treat patients. But this is a final, desperate attempt to change the situation for doctors in our country. For the last 20 years we have very politely listened to politicians saying that there will be reform and things will improve when there is enough money and that things will get better soon. But it has been 20 years of empty promises and we have had enough. Our patience has run out and we cannot wait any longer.” www.thelancet.com Vol 377 January 8, 2011
Doctors in the Czech Republic have long complained of poor working conditions and underinvestment in the health sector, with government spending on health care below the western European average. The Czech Doctors’ Chamber (CLK) says that the Czech Republic spends about 7% of its
“Dissatisfaction with conditions has led to a brain drain, with doctors leaving to work abroad for much higher salaries, especially following the Czech Republic’s entry into the European Union in 2004...” gross domestic product on the healthcare system every year and it wants to see that raised to at least the western European average of 8%. It also says that doctors are grossly underpaid. Newly graduated doctors earn a basic salary of just over €650 per month, the CLK says. The country’s average monthly wage is about €900. Vedralova told The Lancet: “A Czech doctor who has just qualified, after years of extremely hard study, does not even get the average wage. “Because the hospital system is bad, doctors are also forced to work huge amounts of hours and break labour laws on working times. People say that a senior doctor has a large salary of about €1700 per month, but when all the hours he or she has to work are taken into account that is not the case”, Vedralove argues. “A doctor can do as much as 300 hours per month with all the overtime and double shifts they have to work. When that is calculated they end up being paid the same hourly rate as someone who works in a fast-food outlet. And these are people who are not serving up quick meals but are being asked to be responsible for patients’ lives.”
Dissatisfaction with conditions has led to a brain drain, with doctors leaving to work abroad for much higher salaries, especially following the Czech Republic’s entry into the European Union in 2004, which opened up the western European job market. The CLK says that roughly 250 doctors leave the country to work abroad every year. It says that most doctors who leave are in their 30s and 40s at the peak of their career potential, and a poor state of postgraduate medical education means that many young doctors are leaving to take up work in other countries as soon as they finish medical school. The brain drain is now threatening to go from a steady stream to a torrent as resignations are handed in. There are fears that a large number of those giving in their resignations are planning to take up posts abroad— from where it would be much harder to persuade them to return to Czech hospitals were a solution to the crisis to be found. Local media have reported that recruitment fairs for Czech doctors for positions in German and Austrian hospitals have been packed, and that there has been a sharp rise in the number of doctors taking specialised German-language courses. One institute offering such courses— which are required for doctors to work in Germany—claimed there had been a 30% rise in applications in December. The severity of the situation has not been lost on the health ministry, and Heger has said that preparations for contingency plans are being drawn up. Heger said that the government would be forced to dip into funds held for national emergencies, such as were used after the devastating nationwide floods in 2010, to pay specialist doctors to return to work. He has also said that 111
Reuters
World Report
A Czech doctor wears a T-shirt saying “Thank you, we’re leaving” during a wage protest in October, 2010
if wards are left short staffed and some operations cannot be undertaken, hospitals will be merged and patients sent to other parts of the country for procedures if necessary. The CLK has painted an equally grim picture of what will happen if, it says, the government does not deal with doctors’ complaints about the system. CLK vice-president Zdenek Mrozek told The Lancet: “If our government stands aside on this issue as it has until now there is a big risk that the healthcare system will collapse nationwide. A certain number of hospitals will be forced to close and others will be forced to close at least some wards. This means that even emergency care might be endangered in some places.” Heger maintains that there is no money in the health-care budget to meet the doctors’ wage demands. In an open letter published in the Czech media, in which he also claimed some doctors had been put under pressure to resign, the minister said that it was impossible in the current financial crisis to fund wage rises. He urged doctors to be patient, pledging that as soon as the economic crisis abated reforms would be undertaken. But he criticised the LOK and CLK for an increasingly “aggressive” campaign of protests which had “crossed the boundaries of decency”. The head of LOK, Martin Engel, angrily dismissed the minister’s remarks. He denied LOK or CLK had 112
put any pressure on doctors or operated an aggressive campaign, and accused the ministry of making false claims instead of trying to find a solution to the problems that led to the protests. Doctors have also questioned the claims that there is no money to fund wage rises despite the government announcing this month a €634 million investment in facilities for teaching hospitals. Vedralova told The Lancet: “It is also an insult to doctors for the health minister to turn around and say that there is no money available for wage rises and then announce they are putting hundreds of millions of euros into teaching hospitals.” Doctors argue that money can be found for wage rises from existing funds within the health system by cutting back on expenditures many of them see as needless, such as spending on buildings and expensive drugs and equipment. “There is also so much money given to the healthcare sector which goes into building and reconstruction projects and facilities and equipment but not into doctors’ wages. So the problem, or at least a main part of it, is to do with distribution of money in the health sector”, Mrozek told The Lancet. Even before the rash of resignations, hospitals had said that there was an acute shortage of doctors in internal medicine, surgery, and anaesthetic and resuscitation wards. Some doctors have already told The Lancet privately
that they know of cases where patients’ health has been jeopardised because of staff shortages. The wave of resignations now threatens to make the situation much worse. In midDecember, as the first resignations were handed in, one hospital in the southern Vysocina region said that 500 doctors had handed in their notice—80% of its staff. Hospitals in other major cities such as Ostrava and Brno have said that they could lose between 60% and 70% of their staff. Heger says he is hopeful that the number of resignations will not reach the thousands predicted by doctors’ unions. He has also said that some doctors have spoken to hospital managers to ask if they can hand in their resignations but return to work once the protest is over, and that he is expecting that those who do hand in their resignations will at least work their full 2-month notice period, rather than just walk out. At the moment there seems little hope for a resolution. Union leaders say that they have no choice but to continue with their protests and the health ministry has repeated its stance that there is no money to meet wage demands. Heger has, however, said that he will resign if more than 7000 doctors hand in their notices. However, the appointment of a new health minister, no matter what he or she offers doctors, is unlikely to move things forward, as doctors’ unions say that they have all but lost any trust in politicians’ promises. As LOK president Martin Engel told Czech media: “Every minister up until now who has attempted any kind of reform steps was either removed from their post or resigned before they could implement any of their plans. I have heard promises that the situation for hospital doctors will get better ‘soon, if only they can hold on for a bit longer’ many times in my career. But they have always remained just that— nothing more than promises.”
Ed Holt www.thelancet.com Vol 377 January 8, 2011
Czech doctors resign en masse Hospitals in the Czech Republic are bracing themselves for service disruptions as thousands of doctors resign in protest over poor working conditions and low pay. Ed Holt reports. Czech health minister Leos Heger has admitted that the government could be forced to use emergency reserve funds to keep hospitals functioning, as thousands of doctors begin to hand in their notices as they demand healthcare reforms and pay rises. Doctors’ unions launched a protest campaign early in 2010 demanding reforms to the health-care system and a three times increase in salaries for doctors, warning that if action was not taken thousands of doctors would resign en masse at the end of the year. Thousands of physicians made good on the threat in the first 2 weeks of December, and unions have claimed as many as 4000 could leave before mid January. At the time of going to press, 3800 doctors had already resigned. Some hospitals say that they are at risk of losing up to 70% of their staff, and the health minister has admitted that even emergency surgery could be impossible to undertake. The health ministry remains adamant that it does not have the funds to meet the doctors’ wage demands, but union leaders say that doctors have been left with no choice but to take their drastic course of action. Jana Vedralova, deputy chair of the Czech Doctors’ Union (LOK), which has organised the doctors’ protests, told The Lancet: “We don’t want to destroy the health system. We want to treat patients. But this is a final, desperate attempt to change the situation for doctors in our country. For the last 20 years we have very politely listened to politicians saying that there will be reform and things will improve when there is enough money and that things will get better soon. But it has been 20 years of empty promises and we have had enough. Our patience has run out and we cannot wait any longer.” www.thelancet.com Vol 377 January 8, 2011
Doctors in the Czech Republic have long complained of poor working conditions and underinvestment in the health sector, with government spending on health care below the western European average. The Czech Doctors’ Chamber (CLK) says that the Czech Republic spends about 7% of its
“Dissatisfaction with conditions has led to a brain drain, with doctors leaving to work abroad for much higher salaries, especially following the Czech Republic’s entry into the European Union in 2004...” gross domestic product on the healthcare system every year and it wants to see that raised to at least the western European average of 8%. It also says that doctors are grossly underpaid. Newly graduated doctors earn a basic salary of just over €650 per month, the CLK says. The country’s average monthly wage is about €900. Vedralova told The Lancet: “A Czech doctor who has just qualified, after years of extremely hard study, does not even get the average wage. “Because the hospital system is bad, doctors are also forced to work huge amounts of hours and break labour laws on working times. People say that a senior doctor has a large salary of about €1700 per month, but when all the hours he or she has to work are taken into account that is not the case”, Vedralove argues. “A doctor can do as much as 300 hours per month with all the overtime and double shifts they have to work. When that is calculated they end up being paid the same hourly rate as someone who works in a fast-food outlet. And these are people who are not serving up quick meals but are being asked to be responsible for patients’ lives.”
Dissatisfaction with conditions has led to a brain drain, with doctors leaving to work abroad for much higher salaries, especially following the Czech Republic’s entry into the European Union in 2004, which opened up the western European job market. The CLK says that roughly 250 doctors leave the country to work abroad every year. It says that most doctors who leave are in their 30s and 40s at the peak of their career potential, and a poor state of postgraduate medical education means that many young doctors are leaving to take up work in other countries as soon as they finish medical school. The brain drain is now threatening to go from a steady stream to a torrent as resignations are handed in. There are fears that a large number of those giving in their resignations are planning to take up posts abroad— from where it would be much harder to persuade them to return to Czech hospitals were a solution to the crisis to be found. Local media have reported that recruitment fairs for Czech doctors for positions in German and Austrian hospitals have been packed, and that there has been a sharp rise in the number of doctors taking specialised German-language courses. One institute offering such courses— which are required for doctors to work in Germany—claimed there had been a 30% rise in applications in December. The severity of the situation has not been lost on the health ministry, and Heger has said that preparations for contingency plans are being drawn up. Heger said that the government would be forced to dip into funds held for national emergencies, such as were used after the devastating nationwide floods in 2010, to pay specialist doctors to return to work. He has also said that 111
Reuters
World Report
A Czech doctor wears a T-shirt saying “Thank you, we’re leaving” during a wage protest in October, 2010
if wards are left short staffed and some operations cannot be undertaken, hospitals will be merged and patients sent to other parts of the country for procedures if necessary. The CLK has painted an equally grim picture of what will happen if, it says, the government does not deal with doctors’ complaints about the system. CLK vice-president Zdenek Mrozek told The Lancet: “If our government stands aside on this issue as it has until now there is a big risk that the healthcare system will collapse nationwide. A certain number of hospitals will be forced to close and others will be forced to close at least some wards. This means that even emergency care might be endangered in some places.” Heger maintains that there is no money in the health-care budget to meet the doctors’ wage demands. In an open letter published in the Czech media, in which he also claimed some doctors had been put under pressure to resign, the minister said that it was impossible in the current financial crisis to fund wage rises. He urged doctors to be patient, pledging that as soon as the economic crisis abated reforms would be undertaken. But he criticised the LOK and CLK for an increasingly “aggressive” campaign of protests which had “crossed the boundaries of decency”. The head of LOK, Martin Engel, angrily dismissed the minister’s remarks. He denied LOK or CLK had 112
put any pressure on doctors or operated an aggressive campaign, and accused the ministry of making false claims instead of trying to find a solution to the problems that led to the protests. Doctors have also questioned the claims that there is no money to fund wage rises despite the government announcing this month a €634 million investment in facilities for teaching hospitals. Vedralova told The Lancet: “It is also an insult to doctors for the health minister to turn around and say that there is no money available for wage rises and then announce they are putting hundreds of millions of euros into teaching hospitals.” Doctors argue that money can be found for wage rises from existing funds within the health system by cutting back on expenditures many of them see as needless, such as spending on buildings and expensive drugs and equipment. “There is also so much money given to the healthcare sector which goes into building and reconstruction projects and facilities and equipment but not into doctors’ wages. So the problem, or at least a main part of it, is to do with distribution of money in the health sector”, Mrozek told The Lancet. Even before the rash of resignations, hospitals had said that there was an acute shortage of doctors in internal medicine, surgery, and anaesthetic and resuscitation wards. Some doctors have already told The Lancet privately
that they know of cases where patients’ health has been jeopardised because of staff shortages. The wave of resignations now threatens to make the situation much worse. In midDecember, as the first resignations were handed in, one hospital in the southern Vysocina region said that 500 doctors had handed in their notice—80% of its staff. Hospitals in other major cities such as Ostrava and Brno have said that they could lose between 60% and 70% of their staff. Heger says he is hopeful that the number of resignations will not reach the thousands predicted by doctors’ unions. He has also said that some doctors have spoken to hospital managers to ask if they can hand in their resignations but return to work once the protest is over, and that he is expecting that those who do hand in their resignations will at least work their full 2-month notice period, rather than just walk out. At the moment there seems little hope for a resolution. Union leaders say that they have no choice but to continue with their protests and the health ministry has repeated its stance that there is no money to meet wage demands. Heger has, however, said that he will resign if more than 7000 doctors hand in their notices. However, the appointment of a new health minister, no matter what he or she offers doctors, is unlikely to move things forward, as doctors’ unions say that they have all but lost any trust in politicians’ promises. As LOK president Martin Engel told Czech media: “Every minister up until now who has attempted any kind of reform steps was either removed from their post or resigned before they could implement any of their plans. I have heard promises that the situation for hospital doctors will get better ‘soon, if only they can hold on for a bit longer’ many times in my career. But they have always remained just that— nothing more than promises.”
Ed Holt www.thelancet.com Vol 377 January 8, 2011