The protest in the hospitals has been quelled so far. Doctors who complained about unbearable overtime rates and burnout eventually settled for a pay rise. What did young people actually get for themselves? And was a request for seniority appropriate?
Guest I’m asking Jan Přáda was vice president of the Czech Medical Chamber and chairman of the Young Doctors Section.
Most hospitals are returning to normal operations this week. The December protest of young health workers against overtime was ended last Friday by an agreement between representatives of doctors, trade unions, the General Health Insurance Company and the Ministry of Health. Among other things, the agreement will ensure an increase in doctors’ remuneration. Of the money that will go to hospitals next year from the public health insurance, it allocates 9.8 billion crowns to increase employee remuneration.
Doctors who have given their notices from overtime work since December should now withdraw them again. But not everywhere they intend to do it. There is criticism and disappointment among them that they expected more from the agreement. Because the problems, not only with overtime, which the protesters were most concerned about at the beginning, remained unresolved.
The Ministry of Health and representatives of doctors promise that nothing ends with the agreement on salary increases. On the contrary, according to them, it is a start for negotiating changes that are so needed in the domestic healthcare system.
“The other side knows we have that leverage and knows we’re able to use it again. Keeping people under pressure for another month would not be entirely happy,” says Přáda.
Were the doctors really only after the money? Do they have clear ideas about what exactly overtime will look like under the new rules? And are they ready to protest again if health care changes don’t start as soon as possible?
You can play the entire interview in an audio player, in your favorite podcast app or in a video.
What was said in the conversation?
1:00 The opening question is completely clear, weren’t you primarily concerned with money from the beginning? – It didn’t work, the money, that wasn’t the only thing we agreed on, but the last thing we agreed on. Because we announced from the beginning that overtime work is of course enormous, it is long-term, it is not something that would arise now. And there are a lot of other things related to that, including the economic issue for doctors, that they are very dependent on it. We said that it is necessary to reduce the amount of overtime, but it is also necessary to slightly increase the basic salary component so that the doctors basically take plus or minus the same. So that, paradoxically, we are going to make the system more efficient, they are not beaten financially. And that was the reason why we needed to agree on these issues as well.
3:00 I said that you agreed on the money mainly because that is where the agreement is most specific, that is basically the majority of the agreement that you concluded with the Ministry of Health. – You are right. This is one of the things that could be solved right away, other things are of a longer-term nature and they really cannot be solved in a few weeks or months. And you need to work on them. There is some guarantee of postgraduate education, first of all at least in the directly managed hospitals, which is a terribly important thing for young doctors. This was very often, which was also revealed in this event, a kind of force tool on young doctors to be willing to do something outside the law in exchange for education. The other thing, and this is not directly part of the agreement, but it was part of our terms, was re-capping the amount of overtime at that original 416 hours. Hospitals will have to reflect this.
4:00 The agreement is very vague in some passages, and even your colleagues from the health sector understand it as an agreement primarily about money. According to some, nothing will change, they describe the results of the protest as a slap in the face. – I believe that many people can understand it this way. On the other hand, we know that the fact that the overtime will not be resolved is not completely true. Thinking that we would solve it with some kind of central regulation, that just unfortunately turned out to be the case, and we were aware that it probably wouldn’t work at all. But we managed to cap the amount of overtime in the law, we managed to increase the price of labor and we managed to increase the legal awareness of doctors.
9:30 But do you have any, any guarantees that it will really be checked, that the situation will change? – We have promises from the Ministry of Health, from the Prime Minister. Skepticism is right, but if they didn’t want to cooperate on it, they wouldn’t have publicly announced it. – And you are satisfied with those promises, aren’t they very general? – If I am satisfied with them, we will see in the coming months and years, because a promise is one thing, and the fulfillment will of course be another. But I don’t think it would be happy to hold the knife to my neck any longer, to put it in a haughty way, because at this point it probably wouldn’t make any more sense.
12:00 What was the benefit of the increased involvement of the head of the Czech Medical Chamber Milan Kubek and the chairman of the Medical Trade Union Martin Engel in your protest for the entire outcome of the meeting? Didn’t it help that it all came down to basically the money we talked about in the beginning? – It is quite logical that President Kubek got involved, because we are the Section of Young Doctors under the Czech Medical Chamber. It was mainly because no one wanted to talk to us much. By law, they essentially have the right to arrange various meetings where government representatives will be present, which seemed to us to be an appropriate step at the time.
19:00 Aren’t you a little worried that if the ministry doesn’t keep any of those promises to you now, none of what you agreed on will just get done? Have you not deprived yourself of the only lever you could have pushed to meet your demands? If in half a year young doctors go to the same protest, what will be the reaction of the public? – The question is, what higher degree of guarantee could we want.
21:00 And wasn’t it a mistake to proceed with the salary increase so quickly? – We would have to continue the protest for another month or two. But the question is whether this is not something that would rather turn the patient public against us. (…) If the doctors will be able to mobilize again and stomp again? I dare to say yes, because it turned out that quite a lot of things and a lot of changes can be achieved with such an activity.
23:00 We were very often compared to the “Thank you, we’re leaving” event, which I don’t always think was happy. Because our thoughts and our ideas were a little different, although of course the comparison is offered to many people – Different ideas, but both were solved by increasing money. – Because, and we’re getting to it again, this is one of those things that can be, in fact, maybe almost the only thing, solved somewhat ad hoc. But actually the other thing is, and now I’m going to add a little to my own ranks, that the things that were agreed upon at that time were simply no longer monitored by the other party, which was us. I was still at the medical school at the time, but no one noticed. – Because doctors have lost that leverage. They gave the nod to the increase in money and thereby lost the leverage they could have used to push for real reform changes in the health sector. So if you don’t repeat that mistake now? – I dare say no, because the other side, or whatever you want to call it, knows that we have that leverage and knows that we are able to use it again. Keeping people under pressure for another month would not be entirely happy, because the patient public would be more reserved towards us.
24:00 How much time do you give to the ministry? – We have a one-year horizon there.
25:30 What do you say about a possible solution to part of the problems by reducing the system, the number of hospitals and the like? – For myself, I think that reducing the number of hospitals is not a happy solution. There is definitely a solution, not to demolish the barracks, but to restructure the network, not every hospital has to provide care 24 hours a day, seven days a week, provide care in the entire spectrum of fields.
28:00 Didn’t your protest discredit Mr. Kubek’s final request that it should now be about seniority for doctors? – This is a statement that aroused great emotions not only among doctors, but also among the public. I myself find him unhappy and not very well communicated. – Didn’t that reinforce the impression that you are only after the money? – I have to agree, in the media image it was such a slouch at the end. But I strongly hope that after some cooling of emotions, explanation of the whole situation in the following days and weeks, the context of our entire initiative will sound positive in the end.
35:00 A lot of doctors still haven’t taken back their notices from overtime work. It is a big problem, for example, at the University Hospital in Hradec Králové (at the FN Hradec Králové, the doctors’ protest on Tuesday afternoon ended with an agreement, note ed.), in České Budějovice, in Pilsen, in Pardubice. What with this? – In a lot of places, there was clearly a condition that there would be changes in remuneration, when they would return to the old ways and have thousands of overtimes per year again. But they simply don’t want this anymore, and that’s the reason why they haven’t reached an agreement in some hospitals yet. – Is this what they want from doctors in Hradec? – I have no direct news from Hradec. – But from other hospitals yes? From which? – One for all – it’s the aforementioned Motol again.
Special News List “Indebted Czech Republic”
The consolidation package, which is intended to help the recovery of the state coffers, succeeded in getting the government through both the legislators and the president. How did the measures work and how much will the state save thanks to them? And when can we expect the revival of our economy?
Marie Bastlová from the podcast I Ask will interview Minister of Finance Zbyňek Stanjura (ODS) and Chief Economist of Deloitte David Marek. Lucie Stuchlíková and Václav Dolejší from the Left Below podcast then they will discuss why the Czech Republic is increasingly lagging behind other EU countries.
All this already on Thursday, December 14 from 5:00 p.m. in the Vencovského aula at VŠE in Prague.
The event is for students and the public, and you can ask questions too! Due to limited capacity, you need to register for it here.