The prestige and attractiveness of medicine and the medical profession were also a major topic of the recently concluded protest by Czech doctors.
“People apply to study medicine who mainly want to help people and do not think too much about the prestige of the medical profession,” thinks David Marx, vice dean for studies and teaching at the 3rd Faculty of Medicine of the UK.
In the second part of the interview, which he gave for the Vizita newsletter, he also talks about the feminization of the field, to which the system reacts poorly, even though it is a long-standing trend. “I find it absurd Professor Pafko’s statementthat feminization is due to the fact that medicine has a low prestige,” says Marx, adding that the number of applications to medical schools, as well as the proportion of women in the field, has remained roughly the same for many years.
You can read the first part of the interview with David Marx here:
You are in daily contact with medics. What response did the protest actually have at the faculties?
The event had a lot of support among the students. Generationally, they and young doctors have a common desire not to die at work. They want to have time for themselves, for their family. This is not only in the Czech Republic and not only in the healthcare sector. This is a worldwide trend, that’s just the way it is.
Students strongly support increased attention to feminization in healthcare. Around 65 percent of our students are women, the situation is similar at other faculties. This is nothing new at all, this is a long-term trend. The fact that the average female doctor does not reach the same salary or wages as the average male doctor until retirement is a warning. It is a sign of the unprofessionalism of the system, because it clearly does not adapt to social reality, just like in the case of geriatric beds.
I consider Professor Pafko’s statement that feminization is due to the fact that medicine has a low prestige to be absurd. If you look at the number of applications to medical schools over the last 15 years, they are definitely not decreasing, rather they are stable or increasing. And the male-female ratio is still the same.
But for medics, a more stable education system is significantly more important. This is also related to the inequality between men and women. Women’s lower earnings are not due to the fact that they have a smaller head or that they are slower. This is due to the fact that in the Czech Republic a woman usually stays at home with the child. And the system of specialized training for doctors is structured in our country. This means that doctors have to spend five months in this department, seven months here and two years there before they get their specialty. Women can work part-time during parental leave, but the amount of practice is counted in the amount of the time. So if they have, for example, 0.2 full-time hours, the necessary time is doubled.
David Marx (63). He studied pediatric medicine. His medical and teaching career is mainly connected with the 3rd Faculty of Medicine of the Charles University and the Faculty Hospital of Královské Vinohrady, but he also worked at the British University of Birmingham. During the government of Josef Tošovský in 1998, he worked as the head of the cabinet of the Minister of Health Zuzana Roithová. In the late 1990s, he founded and still heads the Joint Accreditation Commission, which monitors the quality and safety of care in hospitals.
So where a full-time doctor has to spend seven months, a five-time female doctor has to spend almost three years?
Yes. That the legislators tried to do something about it is evidenced by one magical provision of the education law: A person who is preparing for a specialization in pediatrics and takes care of a child, that child care is counted as three months of specialization training. Which is completely absurd. That’s like saying that if someone wears glasses, they subtract three months from their ophthalmology training.
However, it would make sense if the structural system was replaced – completely, or at least partially – by a competence system. This means that the doctor has to learn this and that during the internship “round” and prove that he can do it. Not to be there for four or seven months, but to actually do something there. And we can say that there must be at least two months at the same time. This would significantly accelerate educational trajectories. And it would also help the system, because with the current setup, parents of young children are not interested in doing the small jobs.
By changing education, we could show that we are thinking strategically. That we realize that we have to adapt the system to its feminization. It will continue, because there is no indication here or in the neighboring countries that the trend is reversing.
I would see the adoption of the standards for specialty training issued by the World Federation of Medical Education as a big step forward. There they are described at least in the general framework of the basic activity. But I consider the transition to competence education to be essential.
Part of the debate surrounding the protest was also devoted to the attractiveness of medicine as a field. Do you feel that the protest itself contributed to that attractiveness, as its protagonists claimed, or rather harmed it?
People decide to study medicine when they are 17 or 18 years old. It doesn’t deal with prestige. They are extremely socially sensitive, many of them are looking for a certain thrill, watching shows like Scrubs and others. When we ask about motivation, we occasionally hear that it is a stable profession and that they are not at risk of unemployment. A couple of applicants have parents who have a practice and they want to continue it.
But the vast majority of them are young, enthusiastic people who want to help and enjoy it. Also because they see it as intellectual stimulation.
And the wider public assesses the medical condition as a whole rather on the basis of their experiences with doctors and nurses. Therefore, in sociological researches, the prestige of the medical and nursing professions is consistently very high, if not the very first.
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It is so. I just don’t know if the whole system isn’t a little guilty of that. The system works from the patient’s point of view, personal experiences are mostly good. Then it is difficult to explain the internal structural problems and disprove the feeling that even if the healthcare system were a little worse, it would still be very good.
It is in the Czech nature to wait until a really noticeable crisis comes and only then look for a solution. Now, in fact, such a small crisis arose and somehow died down. But we simply cannot do without a strategic solution, including public education.
Many things are actually different than they appear on the outside. When you come up with the idea that a smaller hospital would be transformed into follow-up care, it immediately becomes political. And those who speak for the citizens will begin to fear how corpses will be lying on the sidewalks in the wider area, because – for example – there will be no surgery in Sušice.
But if you look at where people from Sušice go, when they are really sick, they usually go elsewhere. Because they hear the voice of the people who say “don’t go there, they won’t help you much”. And they vote with their feet. But political reality still maintains even these workplaces. Which in turn is unfair to those who don’t have as much information. So the system as it exists has an element of asociality in it.
And even if it doesn’t look like that at first glance, it doesn’t work very well. One of the system quality parameters is the so-called equality of outputs, equity. This means that if someone has a heart attack here in front of the Vinohrady hospital in Prague, while the exact same person has a heart attack in Kardašov Řečica, they both have to return to work at the same time.
It works quite well for an acute heart attack. But there are situations where the availability of care is not very good even in big cities, but it is still radically better there than in more remote areas. Currently, there is a lot of talk about psychiatry and child psychiatry, but also in rheumatology, the availability of care varies significantly across the country.
This in turn is related to strategic thinking. So if the raccoon protest leads to some strategic action being planned, then god bless it. But I don’t see much in the deal.
There is talk of regional gaps in care. Also about the fact that there are enough doctors, but somehow they are not where they ideally should be. Probably no one wants to return to the locations where the state sent doctors where they were needed. Can young doctors be motivated to become pediatricians in the Karlovy Vary Region?
First of all, one must analyze what is discouraging the doctors from doing so. And it’s not money. Municipalities and regions can offer quite generous incentive amounts, apartments and the like. It is often the unavailability of quality schools or kindergartens, clubs for children.
We are not alone in this. In Britain, five or six years ago, they found that practitioners in more remote parts of the country were aging and declining. And they have introduced an educational branch for the practices of remote locations in some medical schools. So in addition to what they normally learn, they have part of the teaching right there, they get to know the work, they get to know the positives and the negatives of those areas. There is also economic support. And some of them gradually identify with that role.
That can be one motivation. The second one, which we are working with for example, is greater cooperation between medical faculties and hospitals in the regions. What I think the South Bohemian Regional Health Holding does very well can also play a role. Young doctors rotate through different hospitals, so they are usable across the region, they are not fixed to one hospital.
Will we have a more reasonable structure of hospitals and a reasonable law on the remuneration of medical professionals in a year?
We probably won’t have a more reasonable hospital structure, that’s for a long time, but we could have some kind of plan. And if we have a law, that is possible. But I would very much hate for it to become a kind of toy in the hands of the medical chamber.
However, it seems that at the moment the chamber is the only one who has a clear idea of what it wants to be written there.
At the same time, it is not the discovery of the wheel. We can see how they do it in Germany, the Netherlands… And I still hope, because it is also written in the program statement of the government, that the level of participation could be strengthened. I think it would be understandable for the population, and it would also be a strong signal for the “raccoons” we started with and will end up with. Because they are the ones who bear the brunt of the banalities, but also of the serious cases that go to hospitals today.
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