An anaesthesiologist in a hospital in Białogard died during a four-day shift. It is a shock for Polish doctors. – We do not want to die of overwork on endless shifts. Moved by this tragedy, on behalf of thousands of young doctors, we are asking for changes that will prevent such tragedies. There are not enough doctors, nurses, paramedics and paramedics. It threatens the health and life of patients. We demand the introduction of regulations that will make it impossible to circumvent the law, say Krzysztof Bukiel from the Polish National Trade Union of Doctors and Damian Patecki from the Alliance of Residents of the Human Healthcare Organization. They have already sent open letters to Konstanty Radziwiłł, the Minister of Health.
A doctor found dead in the hospital. It was Monday, August 8, 2016, evening. It was a heart attack. – On that day, the doctor was on the fourth day of duty – admitted Witold Jajszczok, the press spokesman of Centrum Dializa in Sosnowiec, which manages the hospital in Białogard. However, he underlined: “The suggestion that she had worked for 96 hours and that this could have been the cause of her death is untrue.
The anesthesiologist was not a full-time employee of the hospital in Białogard. – She ran a sole proprietorship, therefore she herself regulated the rhythm and pace of work – defends the spokesman.
This position is condemned by both the medical community and the Ministry of Health. – A doctor who takes up continuous work for four days, without hours due to rest, acts contrary to the code of medical ethics – emphasizes Milena Kruszewska, spokeswoman for the ministry.
Attorney Piotr Pawłowski, who specializes in labor and medical law, added in an interview with PAP: – Even when the contract doctor does not provide any health services, he is still ready to work. Must adhere to the agreed working time schedule agreed with the hospital. During the time of duty, the doctor cannot leave his workplace, he should be at the permanent disposal to perform medical procedures. – Each hospital that has concluded an agreement with the National Health Fund must ensure the safety of patients during the provision of services, so it cannot allow them to be performed by exhausted doctors, and thus unable to work properly.
After the doctor’s death, the Polish Medical Trade Union demands the government to introduce legal solutions that will make it impossible for doctors and their employers to circumvent the regulations on working time.
– In particular, it is necessary to introduce the principle that the allowed working time limits apply to a given person, regardless of the basis of employment and the number of jobs – says Krzysztof Bukiel, chairman of HRM, in a letter to the Minister of Health.
The Association of Residents HRD even believes that the health safety of Poles is at risk. – We do not want to die of overwork on endless shifts. We are too valuable to the society and there are too few of us – thunders Damian Patecki, chairman of the Alliance of Residents of the Human Residents Association. “Moved by this tragedy, on behalf of thousands of young Polish doctors, we are asking for changes that will prevent such dramas in the future. The insufficient number of health care workers in Poland poses a threat to the health safety of Poles. Currently, more and more hospitals have staff problems. The branches are forced to close branches due to the shortage of specialists. All possible steps should be taken to counteract this, otherwise a collapse of the healthcare system is to be expected in the near future. A doctor who works 100 hours non-stop poses a threat to both himself and his patients. If we do not increase the number of doctors in Poland, we will deal with such cases more and more often, ”he writes in an open letter to the minister.
According to the HRM, the main reason for overworking doctors in Poland is their shortage. If the doctors had not worked as long as they are now, many hospitals – in the opinion of the union – would not be able to function normally. The reason for the shortage of doctors is not only the insufficient number of medical graduates, but – especially – the great emigration of doctors, undertaken due to poor working conditions and wages in the home country. – Successive governments, not wanting to do this, allow for breaking the regulations on working time, and thus sweep the problem under the carpet – says the head of HRM.
The union also asks the directors and owners of hospitals to “stop supporting the rulers in this peculiar experiment of researching how much hospital funding can still be limited, how much work can be put on doctors and other medical personnel, and how to significantly reduce employment and salaries for basic working hours. Trade unionists also ask doctors: “Do not succumb to the moral blackmail of directors and do not take up work beyond your strength in order to save the functioning of the hospital. Ultimately, this attitude prolongs the public health crisis, postpones real solutions, and hits the hospital, its staff and patients alike. We appeal to doctors who treat excessive work as a way to earn extra income from low wages, that they should rather take steps to improve their salaries for basic working hours than lose their strength and health by more and more on duty. Let the first step on this path be the mass participation of doctors in the demonstration on September 24 in Warsaw, writes Krzysztof Bukiel.
Damian Patecki claims that doctors’ working time should be assigned to the right to practice their profession, regardless of the form of employment and place of work. He asks the minister of health publicly about the permissible working time of a doctor in Poland? “Does existing legislation not sanction the circumvention of the law? Why is it enough for a doctor to start a business, and he can work legally for several hundred hours without a break? ”.
– The minister will refer to both sent letters as soon as they formally reach us – Milena Kruszewska, spokeswoman for Konstanty Radziwiłł tells MedOnet. Before the letter is officially received, it already comments on the information contained in our text:
– The Ministry of Health is not planning changes in the scope of regulations concerning doctors’ working time – explains Milena Kruszewska. – The applicable legal regulations, in particular the Act of 15 April 2011 on medical activities and the Act of 5 December 1996 on the professions of physician and dentist, allow the employment of medical professionals in a medical entity, both on the basis of an employment contract and a civil law contract. The decision and choice regarding the workplace and form of employment depends on the will of both parties. The provision of art. 5 of the Act on Medical Activities provides that a doctor may practice his profession as part of a medical activity in the form of a sole proprietorship as an individual medical practice, in the form of a civil partnership, general partnership or partnership as a group medical practice. Practicing as a doctor is therefore possible both on the basis of an employment relationship, a civil law contract or under a contract concluded with a professional practice. In addition, a doctor may practice as an entrepreneur in a private practice. This also applies to nurses and midwives.
The fact of practicing the profession of public trust implies, in particular, the obligation to be guided by the principles of ethics requiring the doctor to be guided primarily by the good of the patient and care for the good of the profession understood as an action that does not undermine confidence in the medical profession. The head of the hospital is in accordance with Art. 46 of the Act on Medical Activity, responsible for the management of the facility under his responsibility – for shaping the legal relations between the hospital and doctors in such a way that will allow, above all, to care for the patient’s welfare (an overworked doctor undoubtedly does not guarantee proper care for patients). Also a doctor, nurse, midwife (practicing the so-called freelance included in the group of public trust professions), whose declaration of will is as important when concluding a civil law contract as the declaration of intent of the hospital manager, should take into account the subsequent possibility of actual implementation of the provisions of the contract. For example, it is possible to point to the Code of Medical Ethics, to which every doctor is obliged to comply under penalty of punishment (including withdrawal of the right to practice), and which indicates the well-being of the patient as the overriding principle of practicing the profession. At the same time, it states that the doctor is not exempt from compliance with this principle by administrative requirements, social pressures or market mechanisms, explains Milena Kruszewska.
It also applies to the other postulates presented in the doctors’ letters:
– The proposed amendment to the regulations was made at the request of the anaesthesiologist community. It is not intended to hinder the process of obtaining the title of a specialist, but to organize it – says Milena Kruszewska. He adds that it is misleading to equate the minimum basic wages with the issue of increases in the health service. This is because the currently drafted act does not specify the amount of salary increases for individual professional groups in the health service – it only indicates the lowest permissible amount of basic salary, below which a medical entity employing medical workers will not be able to determine the amount of remuneration. The draft defines the “path” to the minimum base salaries, which are to reach the target amount by the end of 2021. The amounts of base salaries proposed in the draft result from the amount of financial resources available in the health care system, taking into account the current share of expenditure on health care in GDP. A spokeswoman for the Ministry of Health also says that in order to increase the number of people practicing medical professions, the Ministry of Health is taking steps to significantly increase the availability of pre- and post-graduate training in medical faculties. From 2016, the Minister of Health increased the admission limits for medical studies in Polish. In the 2016/17 academic year, the admission limit for full-time medical studies conducted in Polish at medical universities (supervised by the Minister of Health) increased by 2015, i.e. by 16 percent, compared to the admission limits in the 468/14,25 academic year. All activities undertaken by the ministry are aimed at improving the entire health care system, which will also contribute to the decision by doctors and other medical workers to stay in the country.
– A real plan for increasing expenditure on health care is presented in the strategic document “National Health Service” concerning changes in the health care system in Poland for 2016-2018. The presented strategy assumes a gradual increase in public funds to the level of 6%. GDP in 2025. Establishing the achievement of such a level of public expenditure on the health service results from a rational assessment of the state’s financial capabilities, while the level – from a comparison with the health budgets of our region – says Milena Kruszewska. However, incl. this is the fragment of the reform announced by minister Radziwiłł regarding the increase of funds for treatment to 6 percent. PKP, but in 2015 it caused an avalanche of dissatisfaction among doctors and the announcement of nationwide September demonstrations. More than a month until the demonstration. Let us hope that by then the doctors embittered by the reform program will meet the minister halfway. And it will be a half-way that will save Polish patients.