Thousands of doctors will not be working overtime in their hospitals in December. Patients across the country are already receiving messages about the postponement of planned procedures and hospitals are preparing to limit care. Can a protest avert anything?
Guest I ask I was chairman of the board of Prachatice Hospital and chairman of the Association of Czech and Moravian Hospitals Michal Čarvaš.
According to the Czech Medical Chamber (ČLK), approximately six thousand of the 13 thousand doctors who start working in hospitals will not work voluntary overtime from December. Representatives of the protestors said that thousands of examinations and hundreds of operations would be postponed as a result. However, hospital directors are reassuring by saying that December is the month when the fewest procedures are traditionally planned.
Despite repeated meetings of the Ministry and representatives of doctors, it has not yet been possible to avert the protest. On Thursday, the unions and CLK should also meet with Prime Minister Petr Fiala (ODS). “The demands of both parties are so sharp that even a compromise between them does not seem realistic at this moment. That meeting (with the Prime Minister, note ed.) will definitely not happen the first time. I no longer believe that something would be reversed in December. He will want to find his way around the problem, and I don’t expect that he would undermine his minister at the first meeting,” said Čarvaš.
The ministry offered 6.8 billion crowns from the year-on-year increase in payments for hospitals to pay doctors. During further negotiations, it increased the amount by almost two billion. However, representatives of the trade unions and the medical chamber rejected it, because according to them, the increase would not apply to all doctors.
Is the protest started by young doctors justified? What awaits patients in hospitals after the New Year? And how to solve current health care problems?
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What was said in the conversation?
1:00 According to the available data, around 6,100 doctors have resigned from overtime services across the country. How will we as patients feel in December? – I think you will feel it in less restrictions on health services and maybe longer waiting times. In general, December tends to be weaker in terms of production, because in many hospitals operations are reduced before the holidays, planned things are done, such as painting on jipkas and the like. There are not so many surgeries in December, because most patients do not want to stay in the hospital during the holidays. They do more or less mainly acute cases. – So it won’t be so dramatic? – It depends on how many doctors will join and with what expertise, especially in those hospitals where a lot of anesthesiologists will join, so of course the number of operations will be limited there. He will definitely feel it more there. Somewhere, they will feel it more in the emergency department, ambulances, depending on how the traffic is organized.
3:00 Is there anything else that could avert the December restrictions? – I’m an optimist, but December is clear, the services are listed. And negotiations with the ministry ended in a stalemate on the basis of salaries, where the ministry’s offer was not actually accepted. The demands of both parties are so sharp that even a compromise between them does not seem realistic or possible at this moment. – Will Prime Minister Fiala’s meeting with the doctors change anything? – The strike can be suspended immediately, the changes can be rescheduled and something else can be done with the operation. But we, as an association, also asked for a meeting in an open letter and pointed out a lot of things that we see with young doctors as well, where the Czech healthcare system should move, what needs to change so that both regional hospitals and state hospitals can function . I think that the negotiation will definitely not happen the first time and that something would be reversed in December, I no longer believe that. (…) He will want to find his way around the problem and I don’t expect that he would sink his minister at the first meeting.
5:00 a.m. Why is it that no resignations were filed at your small hospital that you run? – Problems are everywhere. On the other hand, Prachatyk hospital is not the only one where no notice is given. On the one hand, it is due to the fact that we try to communicate with those people, we try to solve the operational issues in the long term and we try to accommodate them. On the other hand, they also perceive that in a small hospital the doctors in the department are closer to each other. And at the moment when there are eight of them, if half of them go on strike, they know that the traffic is not going to work. And I think that my doctors are very loyal to the patients and to the hospital, which they see as their base, where they want to continue working. – So those doctors who resign are not loyal to their hospitals or patients? – I don’t know, you can’t generalize like that. But the question is, when you are in a team where there are 65 of you, and when 15 of them resign, you know that you will not actually restrict the patient or endanger his life. And that other colleagues will do the work. When you are in a small team, in a small hospital, you perceive it a little differently.
8:00 a.m. What is the strike against? Is it about salaries or that doctors are overworked? What would you name it? – There is probably some truth in each piece. If I wanted to paraphrase it, it is perhaps a strike against the arrogance of power, against the fact that someone prescribes something and does not always create the conditions for it to work. We have a very high-quality Czech healthcare system, patients are taken care of, but the patient has the right to absolutely everything, but there is a lack of responsibility. And our doctors are actually the only ones who take care of patients 24/7, non-stop in emergency rooms. They feel that after LSPP was canceled in a number of regions and places (First aid medical service, note ed.) and all urgent care is transferred to the emergency departments of hospitals as a backbone network, it is only served by our doctors and no one will help them. Practitioners do not get involved, except for clear exceptions, outpatient specialists do not get involved, except for clear exceptions. Our doctors in the emergency room often deal with things that are banal that fall to the practice, for example patients with chronic back problems: “My back has been hurting for a week and now just on Saturday night it started to hurt more, I ran out of pills, so they run out to the emergency room, they’ll prescribe it for me.” The doctor who serves there, be it surgery, internal medicine, or any kind of emergency, is there to deal with patients’ a priori serious conditions. These things are handled by a general practitioner abroad.
10:00 You also mentioned it in your letter to the Prime Minister, how high a fee can you imagine to make it work, to have that regulatory effect? – We also proposed an amount of around 250 to 300 crowns as part of the comments on the reimbursement decree. – Regulatory fee. – Regulatory fee for using the emergency room, with the fact that, of course, if the patient is in a serious condition and is hospitalized, the regulatory fee does not apply. It would work only for those cases that do not end in hospitalization and which to a large extent burden that very system of urgent admissions and emergencies. – What did the ministry tell you about that? – The Ministry rejected it when we discussed it at the Health 2024 conference in September, where the Prime Minister was also present. He also refused. – With it being politically impenetrable… – Yes, that there is no political consensus and that he will not make the same mistake of introducing regulatory fees again. It’s a political issue at this point.
13:00 But it’s not just a question of regulatory fees, it’s a question of the education system of Czech doctors, who today are a force of attraction to teaching hospitals, where they then complain about some treatment of them and the like. At the same time, there is a lot of capacity in regional hospitals where we would like to educate, but we actually can’t due to various administrative restrictions that are set by professional societies and the like. (…) In order to be able to educate in that performance, you must have the approval of the accreditation commission, and we have a million fields of accreditation commissions, a million professional companies that build their requirements into everything, and in the end, the system is terribly complex. Some future doctors serve for this, some still study according to the system before Vojtěch Adam, some after him, and they have different study programs and in different study programs they have different numbers of procedures and different requirements that they have to fulfill. And then when he goes to Olomouc for an exam, they want something different from him than when he goes to Prague or Pilsen for an exam. And if you don’t train doctors in those small hospitals, you’ll essentially depopulate them.
14:30 Who is preventing the change? – I think there are certain groups here that are comfortable with that. – Who? – They are professional societies that are mostly patronized by professors from teaching hospitals. They have that education built to suit them. If I’m honest, a lot of doctors in teaching hospitals of that type also have several jobs, work as a doctor, work at the medical school, private practice. After all, we saw it with Minister Arenberger. – So, to a large extent, the largest university hospitals and the professorial capacities that control the individual fields in them, if I understand you correctly, are preventing the change or legalization of the Czech healthcare system to a large extent? – In fact. – Where to get out of this? – It is necessary to somehow cut into it and listen to what they want. If young doctors say it, the Czech Medical Chamber says it, hospital managements who are dealing with it in practice say it, then logically those groups who are bothered by it say it. The groups that don’t respond are the ones that are comfortable with the status quo.
19:00 It is often heard that the Czech Republic does not have so few doctors and that one of the solutions could be a significant reduction in the network of medical facilities, a reduction in hospitals. You have already stated that you are against it. – Maybe we have too many patients, we can’t tell those patients that we will raise their fees. And we come back to the same problem. At the moment when the patient with us has the right to absolutely everything, so if he has a problem, he can come to Prachatice on Monday for an X-ray, undergo a professional examination, say to himself: “I would like another opinion, so I will go on Tuesday to Strakonice, on Wednesday to Tábor, on Friday to Písek, next Monday to Motol. They do the same examinations everywhere, they all bill it to the health insurance company, and the health insurance company reimburses it as part of the reimbursement.” And the patient can receive that care and is not actually restricted in any way. The circuit doctor who should perform it with that system is not there. – But that sounds as if you were saying that the main problem of the Czech healthcare system is patients. – No, the problem is non-functioning primary care and the link between primary and hospital care.
20:00 What will happen to the strike now? Can anything unblock this situation? – We need to continue to act, we want to look for compromises. Because if the strike continues, production will be limited, so logically it may not even be for the salaries they are today, let alone for any addition. – In this economic climate, isn’t it time for the unions to back off? Isn’t that beyond reality? – That’s more of a question for them. Money is important, the problem is in the setting of wages and salaries, but the problem is also in the other things we mentioned. Especially in education, especially in the issue of patients, in medical schools, in medical faculties, in how many future doctors will be educated, also in how electronicization will be set up, how the control of insurance companies will work towards patients and so on. It’s a lot of interconnected things that, if the minister starts to change, the willingness of the strikers to believe that something will change will also be possible.
25:00 I think the main block at the moment is not money, but it is a question of trust, if the politicians are willing to do something about it and change something.
I am asking, Marie Bastlová
Podcast Marie Bastlova. Hard talk interviews with people who have influence, responsibility, information.
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