Poll: ‘Thank you, we’re leaving’ is blackmail

In September 2010, the Czech Doctors’ Union (LOK), led by Martin Engel, launched a nationwide campaign called “Thank you, we’re leaving” aimed at convincing as many hospital doctors as possible to hand in their notices by the end of 2010.

The main reason for this was the discontent among doctors over pay. Nonetheless, this was not the only reason. A further 12 arguments have been posted on LOK’s website.

In the week beginning Dec. 27, resignations were sent to individual hospital departments. There were around 3,800 resignations in all, despite LOK expecting a much higher number. These doctors are now working through a two-month notice period and they can still change their decision.

They say that they could go abroad after leaving the hospitals. They also cite other alternatives such as opening a private practice, finding employment with pharmaceutical companies and leaving the healthcare sector altogether.

Most of the 141 top managers who responded to Czech Position’s “Voice of the Elite” survey are convinced that the state should not meet the doctors’ demands for higher pay. ‘If they can find work abroad, let them go.’

Some responses were uncompromising in their disapproval. “It’s a politically directed lobbying campaign. In state-owned hospitals, in particular, there are 30 percent more doctors than there are in private ones. There is no interest in 3,000–4000 doctors in Germany, or even in other EU member states. If they can find work abroad, let them go. It’s good for us, as they will gain experience.”  

Another respondent was equally negative. “Doctors deserve higher pay, as do teachers, police officers, scientists and many other state employees. For many reasons, however, the state does not have the money for this,” the respondent said.

“First of all, it is necessary to reform the state budget, in terms of both expenditure and revenues. This includes major changes in the health service. For example, inefficient spending should be reduced and efficiency increased so that doctors only do specialized work. Doctors’ performances should be improved,” the respondent said.

Practical medicine

The respondent went on to offer some solutions. “Patients’ contributions ought to be increased. The option of paying extra for above-standard services should be introduced. The corruption of doctors by patients and pharmaceutical firms should be curtailed or prevented so that a doctor working in the state sector transfers suitable patients to a private practice. After these measures have been taken, then enough money could certainly be found to ensure that doctors get the better remuneration they deserve,” the respondent continued.

“Until this happens, all that we are talking about is redistributing money among several half-empty pockets full of holes — doctors want to take money at the expense of another hungry mouth that is fed from the state’s coffers,” the respondent concluded.

Two top managers took the opposite point of view. “Doctors’ pay is not the biggest problem in the health service. It is being stolen from them in the form of unregulated rising prices for medicines and other medical aids.Breaking the monopolistic behavior of these suppliers is crucial to reform,” the first manager said. ‘A quarter of operations in this country are unnecessary and many of them have not been performed at all.’

This manager also called for costs to be checked. “Some doctors are billing for operations that they have never performed. They don’t serve in hospitals, however. As is the case elsewhere in the world, a quarter of operations in this country are unnecessary and many of them have not been performed at all,” the first manager concluded.

The second manager said that the demands of doctors have been ignored for a long time. “First, the doctors’ demands are fair. Essentially, they have been making these demands and the state has been ignoring them for 20 years. Second, it is not just about money, but also the quality of the system. Third, even if it was just about money, doctors don’t want it from the state budget.They claim, and they are right, that there is enough money in the system. It is simply necessary to stop it flowing into black holes and to use it not only for doctors and healthcare workers, but for patients as well,” the second manager said.

“In 20 years, almost 20 people have been health minister and not one of them has changed anything, or perhaps they have not managed or wanted to change anything. I fear that the current Health Minister Leoš Heger (TOP 09) and the current government also don’t have the wherewithal for real reform, just like their predecessors. The reasons are pretty obvious ­— the lobbying of pharmaceutical firms, builders, and suppliers of anything that the health service needs is well-organized, and the greed of the people in charge of making purchases for the healthcare system is endless,” the second manager concluded.

A dose of reality

In providing negative answers, the next two respondents compared the situation to the one abroad.