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One hundred coronary angiography – that’s what I should do. It’s a theory. I will enter the initials of non-existent patients and the dates of fictitious procedures in the booklet. Older doctors pin it down. Yes, it’s a fake. Disgusting but common – Robert mentions a specialization in cardiology. Young doctors are fed up. Today they are protesting all over Poland – they starve, donate blood, do not go to work. In Medonet, they talk about what and with whom they fight.
- On October 2, 2017, resident doctors, i.e. medical graduates in the course of their specialization, begin a nationwide protest. They starve, donate blood, don’t come to work. The campaign was organized by the Alliance of Residents of HTMA, but is supported by the majority of senior doctors.
- The talks between the residents and Konstanty Radziwiłł, the Minister of Health, ended in a fiasco. Doctors want pay raises and internships that will not be fictional, but will provide specific knowledge and the possibility of performing operations under the supervision of older colleagues. They also fight to improve the situation of patients.
- Pathetic wages, too much work, no time for the family and for education. No prospects – that’s what residents say about their lives. Some of them are still fighting, they hope for a change, some admit that they were sure already during their studies that they would flee Poland.
Between 2009 and 2015, Romania lost half of its doctors. They left. A similar situation threatened the Czechs. However, local doctors repainted the ambulance as a hearse with the inscription: “We are leaving, you are dying.” It worked. The Czech government raised their wages, improved working and training conditions. Doctors stopped leaving. Poles can protest in defense of the independence of courts, the Constitutional Tribunal or against the ban on abortion. However, they do not go out onto the street when they are blind while waiting in line for cataract surgery or when they are assisted by an unconscious doctor who has been on duty continuously for 30 hours. How the authorities treat doctors, their training, working time and salaries reflect the attitude towards all Poles, because sooner or later each of us will get sick.
How are we losing specialists?
Marek was supposed to leave the hospital at three o’clock, but his boss told him to stay longer because there was a sudden reception. It took him more than two hours to complete the necessary research and write out the orders. There was so much work to do that he didn’t even realize that it was suddenly after five. They called from kindergarten. They said that if he did not pick up his son in a moment, they would call the police, because they had already finished work, so the child would be left unattended. Crazy driving around the city, after two days on duty, is a feat. No breathalyzer will show it, but the body’s reactions are slower, as in a drunk with one ounce of alcohol in the blood. Fighting sleepiness immediately after returning home is even more of a challenge. After all, you have to check your older daughter’s notebooks and build a block tower with your son.
Marek specializes in vascular surgery, and Ania in anesthesiology. Their daughter was born in their fourth year of college, a son four years later. During a month, they spend only 6 nights together. The remaining ones are on duty alternately. Those who are not on duty get up at six in the morning. She dresses the children, makes them breakfast and takes one to kindergarten and the other to school. You have to be at the hospital at 7.30 for the check-in. – Fortunately, the traffic jams are not too big at this time, because most people start work at nine – says Marek. Work never ends at 15 p.m., but overtime is not paid. I eat lunch around 4pm at home. After two extensive treatments, I am so tired that if it were not for the children, I would have fallen asleep within 60 minutes. They contact Ania via SMS. When asked why they work so much, they answer that young doctors are on duty without discussion. Each of them, including shifts, earns about 6.30. zloty. However, they pay off the loan for the apartment. Not very large 16.30 sq m, three rooms. But because there is always no one family member, this space is enough – Ania jokes. The car is leased, which is an additional cost. – I know the children would prefer both of us to be with them in the afternoons. This, however, is impossible. Recently, none of us could go to our daughter for an interview. We had to meet the teacher individually. We told her we could at XNUMXam or XNUMXpm. However, at that time she does not work anymore – says the doctor. Even though the daughter is in first grade, she already has a mobile phone to contact her parents. She checks the picture on the wall and knows who will pick her up from school. The son has just gone to kindergarten and needs more attention and tenderness. And I can’t provide it to him – he complains. They only had one year left to complete their specialization. They don’t want their lives to be like that. They dream to be a normal family. Therefore, when they become specialists, they intend to go abroad. They do not believe that anything will change in Poland.
Nobody has to live heroically
According to NRL estimates, up to 30 people may work abroad. Polish doctors. It is estimated that 10 percent. Polish medical graduates go abroad, mainly because of earnings, shorter working hours, and greater opportunities for professional development. The bureaucratic reporting requirements of the National Health Fund are not without significance. Meanwhile, in terms of the number of inhabitants, we have the lowest number of doctors in the entire EU. In Poland, there are 1000 doctors per 2,2 people. This is the worst result in the EU and 50% lower than the EU average. – I do not see anything wrong with the fact that young doctors leave Poland with a lot to win and little to lose – says the ethicist and philosopher prof. Zbigniew Szawarski. When asked whether the possibility of leaving the country educated for state money should be blocked for physicians, he says: no. – A young man graduating from university wants to invest in himself and the trip gives him this opportunity. It creates an opportunity for a decent standard of living with the possibility of rest. Emigration also tempts with the promise of better organization of work, good retirement and better professional prestige. It is an escape from the oppressive bureaucracy imposed by the National Health Fund, feudal relations in hospitals or the political situation. Because what kind of career can a doctor who wants to deal with IVF make in our country? – says the professor. According to the philosopher, if a young person is to put at stake social and personal welfare, he has the right to choose his career, the prospect of talent development, fulfilling professional dreams or a successful family life. – Nobody is obliged to live heroically – he emphasizes.
They leave before they become specialists
Robert and Edyta are in their second year of specialization. He will be a cardiologist, she will be a gastroenterologist. They are going abroad in a month. Everything’s taken care of. They say they won’t be back. – We are leaving Poland because we want to educate ourselves and live normally. I’ve been the best in the year and I’m going to be a great specialist. In Poland, I have no chance of reliable specialization training – says Robert. After graduation, a young student of medicine cannot have an eye operation or a heart transplant. For about six years, in the course of specialization, he has to learn to perform many procedures within the chosen profession. However, in a Polish hospital, doctors who are supposed to train younger colleagues are not paid for it. – My guardian has so much to do that he is not even able to talk to me. In my specialization, as part of my education, I should do, for example, one hundred coronary angiography and implant 25 stents under the supervision of my tutors. However, this is only a theory, because at the end of the specialization, I will enter the invented initials and dates of the supposed procedures performed in the procedure book and the older doctors will sign and stamp these procedures for me. This is an obvious forgery, but disgustingly common. I suspect that less than 10 percent of people with a specialization in cardiology will have a coronary angiography or a stent inserted, but all will have entries in the specialization booklet. As a result, the patient suffers from this pseudo-training – complains Robert. There are no doctors in the hospital, so a trainee resident works 300 hours a month. It’s hard to find time to learn. – In addition, in the hospital, instead of taking care of patients, I type the drugs used in the ward into the computer. So my medical skills don’t grow from this. Such work could be performed by someone in whom the state has not invested hundreds of thousands of zlotys for six years of study and three years of specialization – he adds. As part of training, doctors are used as cheap labor for paperwork. So it is not a training, but the presence in a specific unit and filling various staff gaps there. – If we manage to train in something, it is only by accident – he says. Robert dreams of being a good cardiologist. Besides, he would like to buy himself a car and a flat. Currently, he earns 2200 zlotys on hand, and his girlfriend 2600 zlotys. So they can’t afford it. They also cannot think about starting a family, because there is no time for it, and they would have to spend almost all of one salary on renting a flat. paupers who work in conditions that are offensive to human dignity, he says.
The domestic help will earn more
Medics associated in the Alliance of Residents remind Health Minister Konstanty Radziwiłł that a few years ago, when he was the president of the medical self-government, he demanded from the then head of the Ministry of Health that the salaries of doctors during the specialization should be the equivalent of two national averages. Today, being a minister himself, he does not want to raise the salaries of doctors. – It is not an excessive demand that someone who is entrusted with the most valuable thing in the world – people’s lives – earn more than the national average – says a doctor specializing in oncology. Currently, doctors who, after completing six years of study and a one-year internship, start a specialization lasting about 5 years, earn from PLN 3170 to PLN 3890 gross per month. The monthly gross salary of an adviser to a private client at a bank amounts to PLN 6. PLN up to 15 thousand. PLN, construction manager from 8 thousand. up to 12 thousand zloty. On the other hand, a doctor who will not take care of the sick, but will work in a pharmaceutical company, will earn from 15 as a product manager. PLN up to 22 thousand. zloty. Such a salary is not offered to doctors by the government law even in five years’ time. The increase in expenditure on financing health care is also postulated by patient circles, because low-earning doctors leave the country, and the waiting time for treatment is extended. Krystyna Wechmann, president of the Federation of Amazonian Associations, appeals to the government to allocate more funds to health care instead of increasing the financing of the army. – Our most terrible enemy is disease and more resources are needed to fight it – he argues.
The medical student is already thinking about emigration
Summer internship in Sweden was an opportunity for Ola to see what her future job should look like. Not only the earnings were shocking, but also the appearance of the hospital, which resembled a luxury hotel, only that it was deserted. Every morning in a neglected Polish clinic, crowds of patients wander along the corridor with towels to the bathrooms. In Swedish, everyone has a single room with a shower and toilet, so if they leave, it’s only to the buffet. In Sweden, a doctor is given official clothes, which go to the hospital laundry after work. In Poland, you wash your apron, which costs about PLN 100, at home. In a Swedish hospital clinic, patients are scheduled on an hourly basis. The waiting room is empty and quiet. Before the patient enters the office, the doctor reads the documentation. He is not allowed to write or look at the monitor during the visit. He must maintain eye contact with the patient all the time. He also does not list referrals or prescriptions, because this is what the nurse does. After the patient has left, he describes the course of the visit using a voice recorder. The recording is written by the medical secretary and included in the documentation. Most Swedish doctors finish work at 16.00 p.m., which is important – they don’t run until the next one. During work, he has a break for lunch on his schedule. When Ola goes to hospital for an internship after six years of study, she will earn 1750 zlotys – less than her friend who works as a waitress. It is uncertain whether she will be able to do the internship at her place of residence. It may be directed to another city, so you will have to rent an apartment. Ola dreams of being a gastroenterologist, but already knows that there are no training places. So he has to choose a different specialization. – Those with rich parents do their dream specialization in volunteering, i.e. after graduation they work for six years for free. In addition, they have to pay for training, their own medical liability, fees of the medical chamber. But Ola’s parents could not afford to support her for another six years. – In my situation, isn’t going abroad the only chance to fulfill my professional plans and dreams? – he asks.
Exploitation as an element of the health care system
The exploitation of doctors is inscribed in the Polish health care system. There is no question of raises, because they would start working according to the hourly standards, and then in hospital wards, patients would be alone for half a day and all night. Meanwhile, in a system based on exploitation, the quality of health care is terrible, and patients endlessly wait to see a doctor or pay out of their own pocket for private visits. However, the death of a 44-year-old anaesthesiologist at the County Hospital in Białogard during the fourth day of on-call duty, nor the death on the fifth day of an anesthesiologist’s duty in Głubczyce, scared no one too much. – Recently, returning from duty, I fell asleep at the wheel. The nervous drivers honked and I slept all the green. Laughter through tears, but the truth is that many of us do not come back alive from the next shift, or even do not come back at all – says one of the residents. By limiting the working hours of doctors to 48 hours a week, the EU allowed Member States in 2004 – as part of the seven-year compliance period – to extend it to 78 hours with doctor’s approval. However, work above the EU norm has become the rule without which the health care system in Poland would cease to function. Poland, as an EU country, should have created appropriate conditions for six years so that a single doctor is not obliged to work more than 48 hours a week. Meanwhile, the reports of the National Labor Inspectorate show that record holders work up to 168 hours, or exactly seven days.
Those who stay
Maria and Stanisław are not planning to leave. – We are patriots and we want to work in Poland. We still believe that something will change here – says Maria. She does pediatrics, he does orthopedics. They have three children. The youngest is two months old, the oldest four years old. It’s hard for them.
– We have long stopped deceiving ourselves that you can be a good parent by returning from a 24-hour shift in the morning. Whoever comes down must sleep. The legs hurt terribly because it happened several hours at the operating table or was running between the ward and the emergency room. The head often hurts, and three children can really make a lot of noise – she says. Without a babysitter, they wouldn’t be able to do it. Because the young doctor does not decide when he will be on duty. However, Maria is most disturbed by the discrepancy between what doctors they wanted to be and what they are. – As parents of three children, we often go to different specialists ourselves. I see the mediocrity that our healthcare system suffers from. I have been waiting for a visit for three months. And when we finally go for it, the doctor has fifteen minutes for the patient, he is tired, frustrated and cannot forget to fill in the paperwork. I know that he, like the patient, tries to somehow cope with this system. However, most patients do not know this – regrets. Maria thinks there is a chance for change. – Poles must
understand that we are on the same side of the barricade. What they see during a medical visit affects us 24 hours a day during work. We are not late to the clinic because we were at lunch. Simply, the procedure in the hospital was prolonged, and we are eating on the way. There are many myths that have to be debunked that doctors are rich, that they only want more
earn that they run from work to work out of greed. We earn below the national average, we spend money not only on a normal life. One of my textbooks costs PLN 300, and a weekly ultrasound course is PLN 2500 – he says. He adds that young doctors do not want to leave their patients’ beds by protesting. He believes that the hunger strike will draw the attention of the rulers to their problems. – Older colleagues – specialists, just like us, are fed up with the conditions in which they work. We still have the energy to fight for changes, and this system sucked the strength out of them. – says. May they have enough of this energy for a long time. Otherwise, there will be no one to heal us.
In Pictures:
1. Hunger protest in the Independent Public Children’s Teaching Hospital, ul. Żwirki i Wigury in Warsaw (photo from the Facebook profile of the Alliance of Residents)
2. Resident doctors Maria and Stanisław with children