– We need hospitals with staff, and we will not miraculously double this. This is something that needs to be worked on and ASAP, Senate President Thomas Grodzky said Monday, correcting the statement that there are enough hospitals in Poland to be around 130 instead of the current 700.
The problem is that the methods used to correct doctors’ flaws in previous governments no longer work. The younger generation who doesn’t want to work overtime anymore to earn a decent living goes to hospitals. If the working conditions are uncomfortable, they go away. There is no one to replace them and fill the tables. Hospital administrators have their hands tied because the government is not helping them solve the shortage of their staff. Experts believe that the only solution is to increase the valuation of health services – they are paid for by the National Health Fund, but also to determine what percentage of the money goes to salaries and what percentage goes to the implementation of benefits. They are also calling for the introduction of mandatory hospital working hours for all doctors, a reduction in employment requirements by the National Health Fund and the implementation of a program that encourages foreign doctors to work in Poland.
Doctors don’t want to die of exhaustion
On August 22, a 39-year-old anesthesiologist at the Alfred Sokolovsky Specialist Hospital in Fabrzych. The Public Prosecutor’s Office in Lower Silesia is investigating manslaughter due to overwork. Dr. Leszek Babis worked 96 hours a week because he was working under civil law contract. He was a contractor, that is, he ran a sole proprietorshipThe hospital has signed the contract with his company. If he works under an employment contract, he can work for a maximum of 48 hours per week. The remaining 41 hours would have to be filled in by another anesthesiologist, which is as lost as the two surgeons. You can also sign an unsubscribe clause in the employment contract, that is, agree to extend the weekly working time to 78 hours. It’s just that most doctors don’t want to work that way anymore. – Fortunately, the mentality of doctors is changing – says Thomas Emila, Vice President of the Regional Medical Chamber in Warsaw. – You can hear statements in the media that if you choose a medical profession, you have to take into account overtime and overwork. Well, no – A doctor doesn’t have to work hard, he has the right to a private life – He adds. Therefore, doctors, especially young ones, will not only protest on 9/11, but also build a white town. – Overburdened doctors, who are tired of the mediocre level of the health care system, along with other doctors, will show the need for real changes – says Agnieszka Sirwan, president of the National Medical Union of Masovian District. Hospital administrators see the problem very well.
There is no one on duty and working in the wings
– The staffing situation in hospitals is bad – says Jerzy Willgolowsky, director of the district hospital of Makov Mazowiecki. – sound The process of mass exhaustion of medical staff and here increases alone will not improve the situation. In the past, the only way to earn extra money was to take extra shifts. Now young people do not want to work much, they want to have a balance between work and family life. And I understand this, but the organizer of the system should think about how to create conditions that will make it possible to realize this vision of work, and on the other hand – to ensure the 24-hour availability of services. Without systematic procedures, the hands of hospital administrators are tied. Employees leave for primary and external health care, because working conditions are more comfortable there – says director Wielgolewski. Jaroslav Madović, medical director of the MEGREZ Regional Specialty Hospital in Tychy, looks at the problem in a similar way. – I think a lot of hospitals have a problem with the staff. Many doctors are retiring, young doctors don’t sign off on the withdrawal clause, and their salaries are decent enough that they don’t have to work 300 hours a month., There is a problem with the graphics. It was before Covid, but it’s escalated now. This problem is blamed on hospital administrators, they are threatened with penalties, but it is a systemic problem, after many years of poor personnel policy. for this reason I will take part in the strike, but to show that the system has become unstable and that it can no longer be fixed at the hospital level – confirms Madowicz.
Another problem arises. The increase in the minimum wage in July aggravated the situation, as it led to the settlement of the wage system. As a result, a specialist nurse earns what a resident doctor earns. I am in favor of nurses being well paid, but the relationship between salaries must be preserved – director Wilgolowsky emphasizes. Marius Bachko, director of the private Zamo Hospital, notes that the resident doctor earns twice as much as the hospital ward. As a result, doctors leave hospitals and wards are suspended or closed, which we wrote in Law.pl in July.
Thomas Emila admits that doctors are leaving hospitals. – I am not surprised that they do not want to work 24 hours, which is not allowed in many EU countries – says Emila. The so-called simplified rules for granting the right to practice a profession during the pandemic.
Doctors from the East will not take the pressure off the system
From December 30, 2020, for the appointment of a doctor from Ukraine or Belarus, it is sufficient to confirm the certificates by the Consul of the Republic of Poland, the relevant declaration of the person concerned, the approval of the Polish Minister of Health to practice the profession and the right to practice the profession granted by the Regional Medical Council (ORL). So doctors must receive two decisions: apart from the decision of the Minister, which is a work permit, and also the right of the ORL to practice the profession. According to Ministry of Health data, 783 applications for a conditional work permit had been submitted by August 23. The minister issued 455 decisions, including 444 positive ones. Citizens of Ukraine and Belarus got the most approvals, and the main specialties are: internal medicine, pediatrics, anesthesiology and conservative dentistry. NS On August 24, 327 applications were submitted to the District Medical Chambers, of which 201 were approved, 17 are negative, the rest are in process. – Not much – hospital administrators agree. Jaroslav Madovich also points out The system of simplified allowances for people from outside the European Union did not work, because the hospital is obliged to take care of a doctorWho does not have a professional qualification recognized in Poland. The law requires that the direct responsibility of such a person must be borne by a physician working for a particular medical entity. For such a solution to be effective, it must be regulated by providing oversight for physicians from outside the European Union, through district consultants in certain regions or designated bodies in the medical room. Madowicz explains.
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Tomasz Emila draws attention to another problem. – The simplified situation is for the duration of the epidemic, and decisions are made to act under certain conditions. When the outbreak is resolved, these individuals still have to go through the normal licensing process. So maybe this will help bridge the gap in pandemic time, but it won’t solve the doctor shortage problem. It is important to improve working conditions and wages so that young people do not go abroad – explains Emila. Jerzy Wielgolewski wants to hire Polish citizens, and believes that if they are not around and won’t be there for some time, people from other countries should be accepted. – It is worth negotiating with the provincial medical rooms about the percentage of foreign doctors that should be employed, but not only. The state must provide them with Polish language learning and training. Currently, I am trying to hire doctors and nurses from Belarus, but this process is going on, and they have to live for something. We hire them as assistants, but this should not be the job of a hospital, but a government entity responsible for regulating health care – he adds. However, the Ministry of Health only plans to increase admission limits for medical studies, annual increases in the basic salary of physicians during residency specialization and loans for medical students. According to experts, this is not enough.
Higher ratings and better working conditions
The employment situation is a structural problem, not just for this government – assesses Jerzy Willgolowski. For years, the limits of medical studies have been very low, and a doctor’s education lasts 12 years. He did not stop going to various trainings and courses and then they leave Poland due to difficult working conditions – says Jerzy Wilgolevsky – only after this period. In the first half of 2021, medical chambers have already issued 295 certificates to physicians applying for recognition of their qualifications in EU countries. In the whole of 2020, there were 505, and in 2019-617. Rafai Houbecki, a spokesman for the Supreme Medical Council, explains that last year there were fewer applications for certification, because everyone focused on fighting the epidemic, but now you can see that their number is increasing. Although it is far from the data of 2005-2007, when about 2000 of them were released. According to hospital administrators, it is sufficient to detain those wishing to leave and encourage those who have already left to return. In the past 15 years, more than 10,000 certificates have been issued for the first time. According to experts, there is only one way. – You have to convince them that young doctors in Poland are treated well, have the possibility of professional promotion, because the system of decrees has been abolished and they can earn a decent living without feeling exploited. – says Wojciech Wiśniewski, health protection expert at the Federation of Polish Entrepreneurs. – The most important thing is but Improving the evaluation of health servicesBecause it is from the funds allocated for its implementation that hospitals pay wages. This is possible because the financing of the healthcare system is increasing. However, we must also clearly indicate how much money the entities receive from the National Health Fund that should be allocated to salaries, and how much benefits will be implemented – emphasizes Wiśniewski. Jaroslav Madović and Marius Bachko are also convinced that assessments should be made more realistic. For example, internal medicine and surgery are underfunded. The issue of the lack of assessment or underestimation by the HSTA was highlighted in the latest report by the SAI. As determined by Law.pl, banners for 9/11 will include the slogan: Agencja Wypeny Medycznych.
Jaroslav Madovich suggests another idea. Today, many patients who have not received a proper diagnosis in primary health care or specialist clinics go to HED or the admission room. The hospital switched to outpatient care, and the doctors working in the hospital no longer wanted to work like that. Here it is urgent to work, for example to link specialist education in family medicine more closely with the hospital, or Introducing oversight for subscription companies that attract hospital staff for better pay, but do not offer a blanket cure. After all, the patient ends up in a public hospital anyway. It is worth starting a discussion that every doctor who provides outpatient services should be connected to the hospital, so that the facilities that ensure round-the-clock care have someone to treat them. This would be a reasonable solution, because we will not have a large number of medical graduates in such a short time to join the hospital staff. If the government does nothing, the hospital administration will soon resign, because the state is not helping them, we are left alone – concludes Madovich.
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